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COPYRIGHT DEPOSIT. 



Vetebinabt Medicine Series 
No. 1 



SPRINGTIME SURGERY 



Edited by 

D. M. Campbell, D.V.S. 

Editor, American Journal of Veterinary Medicine 



Third Edition 
Revised and Enlarged 



Chicago 

American Journal of Veterinary Medicine 

1913 






$ 



^ 



©CI.A346092 
Ml 



Copyright, 1913 
D. M. Campbell 



The Rajput Press, Chicago 



PREFACE TO THIRD EDITION 



Advantage has been taken of the exhaustion 
of the last edition to correct a few typographical 
errors and, at the suggestion of the authors, to 
make slight changes in some of the articles. 

The remarkable sale of this work has made 
necessary the third edition, within a year from 
the date of its first publication. There are many 
evidences that it has proven helpful to a large 
number of veterinarians and that this edition 
will meet with the cordial response given its 
predecessors. 

The Editor. 



Chicago, March 1913. 



Veterinary Medicine Series 
No. 1 



PREFACE TO SECOND EDITION 



The fact that a second edition, of a veterinary 
publication, should be required, within thirty 
days from the time the first edition was received 
from the bindery — thus establishing a new record 
among veterinary publications — is proof positive 
of its usefulness and its welcome. Springtime 
Surgery has had this remarkable sale. A higher 
commendation is scarcely possible, a further one 
unnecessary. 

This work is unique, an innovation in veterinary 
literature, and has appealed strongly to practis- 
ing veterinarians. The thanks of the editor, and 
all credit for the usefulness of Springtime Sur- 
gery, are due to the contributors who have given 
of their time and talents for the enlightenment of 
the Profession. 

Three articles have been included in this that 
are not contained in the former edition, two in 
the former have been omitted from this edition. 
A number of those in the first edition have been 
thoroughly revised for this one by the authors. 

The Editor. 

Chicago, April, 1912. 



SUCCESS 

Pluck will win — its average is sure, 

He wins the fight who can the most endure. 

Who faces issues, he who never shirks, 

Who waits and watches and who always works. 

(Author unknown). 



PREFACE TO FIRST EDITION 



There is an obvious advantage in having 
grouped, in one small volume, really meritorious 
discussions of the cases most common at any 
season. The articles in this book, which are re- 
printed from the American Journal of Veteri- 
nary Medicine, constitute, we believe, the most 
instructive yet brief description, and the most 
helpful case-reports to be gleaned from the liter- 
ature on the surgical and obstetric problems com- 
mon during the foaling and castrating season. 
The discussions of "Springtime Surgery," while 
in no sense exhaustive, yet constitute, for the 
practising veterinarian, a valuable supplement to 
the standard textbooks of veterinary surgery 
and obstetrics. 

The superior merit of these articles amply 
justifies their reproduction in a form more per- 
manent than is offered by magazine publication. 
The frequent requests from subscribers for 
copies of the issues of "Veterinary Medicine" 
containing various of these articles convinces us, 
that their presentation in book form will be wel- 
comed by a large number of veterinarians and 
that this volume will be of much usefulness in 
this field. 

The Editor. 

Chicago, March, 1912. 



TABLE OF CONTENTS 



Castration of Cryptorchids 9 

Practical Methods of Cryptorchidectomy. . . . 39 

Cryptorchidectomy in Horses 75 

An Interesting Monorchid 83 

A Castrator's Error 87 

Hemorrhage After Castration 91 

Castration of Pigs Having Scrotal Hernia. . . 93 

Operation on a Hermaphrodite 97 

Spaying Heifers on Western Ranches 101 

Oophorectomy in Cats Ill 

Prolapsus Uteri: Its Successful Treatment. .113 

Unusual Case of Obstetrics 116 

Proper Replacement of the Everted Uterus. .117 

Pervious Urachus 120 

Care of Navels in Newborn 123 

Superf etation with Report of a Case 133 

Atresia Ani 137 

Treatment of Contracted Tendons in Foals . . . 141 

Minor Means of Restraint 145 

The Treatment of the Injured Hand 153 



Castration of Cryptorchids * 

By W. L. WILLIAMS, V. S., Professor of Surgery and 

Obstetrics in the New York State Veterinary College, 

Cornell University, Ithaca, New York, author of 

"Veterinary Obstetrics," "Surgical and 

Obstetric Operations," etc. 



It is generally considered advisable to castrate 
all male domestic animals which are to be regu- 
larly used for work or as human food. However 
true this may be of normal males, it is empha- 
sized in most cases of cryptorchids or hidden 
testes. 

It is especially desirable that the cryptorchid, 
or the monorchid, be castrated, in order that he 
may not be used for breeding purposes, because 
he may largely transmit the defect to his off- 
spring. In addition to this, the abdominal testicle 
usually induces a perverted sexual desire, closely 
analogous to the nymphomania of the female. 



♦Reprinted from the Missouri Valley Veterinary Bulletin, April, 1910. 



10 SPRINGTIME SURGERY 

Etiology. — The causes of cryptorchidy are 
various, and are not wholly understood. We 
meet with three groups of causes or conditions 
which are of interest : 

1. Arrested development, or descent of the 
organ. 

2. Aberration of the development of the organ 
— teratoma. 

3. Pathologic conditions of the testes. 

In the first case, the testicle forms normally, 
and drops from its embryonic location into the 
peritoneal cavity, but fails to descend into the 
scrotum. It then retains its fetal character, is 
small, soft, flaccid and histologically shows the 
fetal spermatoblasts, but no spermatozoa. The 
gland is therefore without procreative function, 
but induces often a sexual mania. Its position 
varies, being located at any point on a line pass- 
ing from the embryonic seat, near the posterior 
end of the kidney, to and into the internal in- 
guinal ring. 

The second class, the teratoma, comprises a 
widely varying group of dermoid cysts, of al- 
most any dimensions and containing epidermal 



CASTRATION OF CRYPTORCHIDS 11 

debris and structures, such as hair, dental tissues, 
etc. They are highly interesting because they 
suggest that the sexual glands are really of epi- 
blastic origin, as contended by some embryolo- 
gists, instead of mesoblastic, as asserted by most 
authorities. 

The third group comprises extremely variable 
pathologic changes, such as cystic, calcareous or 
other forms of degeneration, malignant new- 
growths, etc. 

These three groups are known to be of very 
unequal size, though definite data as to the pro- 
portions of each are wanting. Ninety-one cases 
have been operated upon in our clinic, of which 
ninety belonged to the first group, none to the 
second, and one to the third. In private practice 
we have met with one additional case of patho- 
logic testicle, but no teratoma. 

The teratoma are considered so unusual that 
they are largely recorded, and probably an ex- 
aggerated idea of their prevalence is acquired. 
It is highly important that these three classes be 
kept in mind, since they have an essential bear- 
ing upon the surgical procedure in castration. 



12 SPRINGTIME SURGERY 

Other less essential elements entering into the 
surgical problem of cryptorchidy are whether the 
testicle is abdominal or inguinal in location, and 
to what species the animal belongs. 

Cryptorchid castration, like many surgical pro- 
cedures, was at first chiefly empiric in character, 
and in fact is still largely practiced as an empiric 
operation, the operation being largely taught and 
learned in a manner devoid of scientific knowl- 
edge. 

Preparation. — The preparation of an animal 
for the cryptorchid operation does not differ ma- 
terially from the general rule for other abdominal 
operations. We desire that the patient shall be 
in prime physical condition, having had abundant 
exercise or work to place him in good, vigorous 
health. Before the operation, the alimentary tract 
should be emptied either by restricted diet or by 
hypodermic catharsis. Fullness of the alimen- 
tary tract should be obviated for general surgical 
reasons and for the special purpose of facilitating 
the operation, by affording greater intra-abdomi- 
nal room and preventing prolapse of abdominal 
viscera through the wound. 



CASTRATION OF CRYPTORCHIDS 13 

Control. — The securing of the patient, in case 
of thfe horse, needs be either in dorsal recum- 
bency, or in the lateral position, with that side 
upon which the hidden testicle is located, upper- 
most. There is but one essential detail in secur- 
ing the horse : The thigh on the side of the hid- 
den testicle must be fully abducted. This may be 
effectively accomplished by many methods of cast- 
ing, and may be perfectly attained upon some 
types of operating table. 

If the thigh is not completely abducted, the 
operator may find his hand so compressed that it 
is soon fatigued and disabled, and the operator 
confused and lost. It is a great error to attempt 
the operation except this abduction is complete 
and secure. Should the apparatus slip during the 
operation, and the operator's hand become com- 
pressed, it is liable to greatly confuse even an ex- 
perienced surgeon. 

The question of general anesthesia is one upon 
which operators may justly differ. For the be- 
ginner, it is the best way. The beginner may, 
under proper aseptic precautions, manipulate an 
anesthetized cryptorchid for half an hour or an 



14 SPRINGTIME SURGERY 

hour, without serious harm to the patient, and 
without seriously transgressing the general senti- 
ment of humanity for animals, which is develop- 
ing so rapidly amongst our people. Anesthesia is 
also highly important for the experienced opera- 
tor. The inguinal region needs to be kept as 
freely open and the tissues as passive as possible, 
this can be attained only by general anesthesia. 

When the beginner is working upon an anes- 
thetized patient, he is relieved from the dis- 
turbances of change in position and the shifting 
in the relations of parts. The abdominal viscera 
are not forcibly pushed against his hand or 
through the opening. It is of great importance 
also that the beginner should be relieved, through 
the general anesthesia of his patient, from the 
confusing and enervating mental anxiety caused 
by the pain he is otherwise inflicting upon the pa- 
tient, as expressed by violent struggling, sweat- 
ing, groaning, etc. 

Again, general anesthesia is always best, even 
for the experienced operator in all cases of com- 
plications, and the surgeon rarely knows that a 
case is complicated until deeply in the operation, 



CASTRATION OF CRYPTORCHIDS 15 

where he cannot retreat or readily modify his 
plans. We believe in general anesthesia in all 
cases. 

Diagnosis.— Some advise rectal exploration 
prior to securing the patient for operation. The 
procedure has certain value. In those cases of 
monorchidy where the scrotal testicle has been 
removed (a very unfortunate and inadvisable 
procedure), the operator may determine definitely 
upon which side the hidden testicle is located. It 
may further give him important information as 
to whether the retained gland falls within our 
first, second, or third class. Should it belong to 
the second or third class, the examination reveals 
to the operator the nature of the conditions, fore- 
warns him of the obstacle to be overcome, and en- 
ables him to plan his operation. 

On the whole, rectal exploration prior to opera- 
tion is largely impracticable. It is generally in- 
convenient to make such examination until im- 
mediately prior to the operation, and at that time, 
it is as a rule imprudent because of the difficulty 
of cleansing the hands properly after they have 
been soiled by feces. 



16 SPRINGTIME SURGERY 

Asepsis and Disinfection — Another point 
of very great importance is the question of dis- 
infection of the operative area, and the main- 
tenance of asepsis. The problem is somewhat 
alike, whether the incision be made in the scro- 
tal, inguinal, prepubian or flank region. In the 
horse, the incision is usually made in the scrotal 
or inguinal region, while in other animals it is 
best made in the upper flank. While the skin of 
the scrotal and inguinal regions is very thin, soft, 
and usually almost hairless, it is nevertheless 
thickly covered with sebum, which is very insolu- 
ble and difficult to remove. Washing for a few 
minutes with any ordinary antiseptic, even though 
preceded by soap and warm water, is of scant, 
if any value. The problem of the practical dis- 
infection of this region has not been solved. The 
profuse application of alcoholic or ethereal solu- 
tions excoriate the delicate skin. 

Careful investigations need be made toward 
solving this problem. Possibly a good method 
would be to wash the parts thoroughly, an hour 
or two prior to the operation, with soap and hot 
water, perhaps mixed with kerosene in emulsion, 



CASTRATION OF CRYPTORCHIDS 17 

or with lysol, bacterol, or carbolic acid. The 
sheath being always dirty bacteriologically, the 
smegma from this should be carefully cleared 
away, and the sheath and prepuce anointed with 
an antiseptic oil, glycerin or vaseline. The skin 
having been allowed to dry completely, when the 
patient is secured for the operation, the opera- 
tive area may be liberally covered with tincture 
of iodine, and allowed to dry before making the 
incision. After the skin incision has been made, 
additional security might be attained by again 
applying the tincture of iodine to the margins of 
the cutaneous wound. 

Incision. — Some operators make their incision 
through the skin and dartos in the scrotal region, 
parallel to the median raphe and one to two inches 
laterally therefrom. Others make their incision 
directly over the external inguinal ring and in the 
same direction. By the first method, the operator 
inserts his hand through the wound in the skin 
and dartos, divides the loose areolar connective 
tissue and pushes aside the numerous vessels, in 
an upward and outward direction until he reaches 
the external inguinal ring immediately at that 



18 SPRINGTIME SURGERY 

point at which the second operator would make 
his incision. 

The incision over the external ring is therefore 
more direct and the resulting wound less exten- 
sive, in which respect it is more conservative and 
preferable. The scrotal, incision has the impor- 
tant advantage over the inguinal, in that the in- 
evitable movements of the thigh after the opera- 
tion disturb the cutaneous wound over the inguinal 
ring, but do not seriously involve the scrotal 
wound. We prefer the scrotal incision. 

Inguinal Cryptorchidism. — Having reached 
the loose areolar tissue in the external abdomi- 
nal ring, whether indirectly through a scrotal in- 
cision or directly through an inguinal wound, the 
operator, with his fingers in the form of a cone, 
and by means of a rotary motion, pushes the 
areolar tissues aside and cautiously advances his 
hand upwards, outwards and slightly forwards 
toward the internal inguinal ring, or the position 
which it should occupy. Care should be taken to 
note here the presence or absence of a dis- 
tinguishable gubernaculum testis, of the epididy- 
mis or of the testicle itself. 



CASTRATION OF CRYPTORCHIDS 19 

If a recognizable gubernaculum is present, it 
may be an important guide to the internal ring, 
and hence an aid of value to the operator, especi- 
ally to the beginner ; or the operator, by grasping 
this and drawing upon it, may bring the testicle 
out through the ring and grasp it. Usually the 
presence or absence of this structure in a recog- 
nizable form may be suspected by the presence 
or absence of a distinct dimple or depression at 
the fundus of the scrotum. 

When the epididymis has descended into the 
scrotum, it is recognized as a somewhat firm cord 
about the size of a man's finger, and is well nigh 
indistinguishable from the stump of the sper- 
matic cord following castration. It is more free 
from adhesions to surrounding tissues, and its 
obtuse extremity is connected with the skin and 
dartos only by the indistinct gubernaculum. Cut- 
ting through the peritoneal sheath of the cord, 
the operator exposes the vas deferens and tail of 
the epididymis firmly attached, naturally, not by 
adhesions, at the distal end of the tubular cord. 
By exerting traction upon the tail of the epididy- 
mis, the head of that organ may be brought into 



20 SPRINGTIME SURGERY 

view, the entire epididymis being abnormally 
elongated and attenuated. The testicle itself re- 
mains firmly lodged above the internal ring, or 
incarcerated in it, and, however much traction 
may be exerted on the epididymis, the gland 
usually remains immovably fixed. 

The first case of this kind with which we met 
led us into error, and we removed the epididymis 
and a portion of the vas deferens, while we left 
the testicle in the abdomen. Later in our clinic 
we operated upon a case, the history of which 
could not be traced, but which had evidently been 
operated upon by some one who had fallen into 
the same error, removing the epididymis and 
leaving the testicle. The condition offers some 
difficulty to overcome. The most direct method is 
to freely incise the peritoneal sheath down to the 
internal ring and either dilate this by forcing the 
finger through the ring along side of the vas de- 
ferens and epididymis, or by cautiously incising 
the ring with a scalpel or bistoury. The testicle 
may then be withdrawn and removed. 

If the testicle itself is encountered in this re- 
gion (inguinal cryptorchidism) the gland is to be 



CASTRATION OF CRYPTORCHIDS 21 

seized and forcibly brought out through the 
wound. Having passed through the internal ring, 
the gland is covered by the cremasteric fascia or 
tendon and by the parietal peritoneum, which are 
to be incised as soon as brought to view, and the 
testicle laid bare. It is to be noted that in all 
cases of abdominal cryptorchidism, including 
those we have mentioned where the epididymis 
has descended into the scrotum, the testicle, when 
brought out, is naked; while in inguinal cryptor- 
chidism, the testicle is inevitably brought out 
covered by the cremasteric structures and the 
parietal peritoneum. 

Locating the Internal Inguinal Ring. — 
Encountering neither gubernaculum, epididymis 
or testicle in the inguinal region, the operator 
should search for and locate the internal abdom- 
inal ring, whether he designs to penetrate it or 
not, as it constitutes the immediate, logical guide 
to the location of the testicle. 

This ring may usually be recognized in the 
cryptorchid horse, as an elliptical slit, appearing 
to the touch as about three-fourths to one and 
one-fourth inches long by one-half inch wide, 



22 SPRINGTIME SURGERY 

directed obliquely forward and outward in its 
greater diameter. It is covered by a thin layer 
of peritoneum, while its margins, the borders of 
the great and small oblique muscles, are distin- 
guished by their greater thickness and firmness. 
This ring is located two to four inches upward, 
outward and slightly forward from the external 
abdominal ring. It is just opposite and very near 
to the crural ring, and, by palpating outward 
against the thigh, the operator easily recognizes 
the pulsating femoral artery as it emerges from 
the crural ring. 

In some cases the internal ring is unrecog- 
nizable by palpation, but the determination of its 
approximate location is nevertheless essential to 
scientific cryptorchid castration. The recog- 
nition of the ring is especially difficult in animals 
previously operated upon unsuccessfully, and fol- 
lowed by the formation of a large amount of 
dense, cicatricial tissue. When the ring has been 
recognized, if the operator will approximate his 
thumb, index, and second fingers to constitute an 
incomplete circle of one to two inches in diameter 
and press the ends of the digits against the abdom- 



CASTRATION OF CRYPTORCHIDS 23 

inal muscles about the margins of the ring, the 
peritoneal curtain closing the ring, the processus 
vaginalis, tends to push outward in the form of 
an obtuse cone, while enclosed within it are the 
gubernaculum and usually the tail of the epididy- 
mis and the base of the vas deferens. The guber- 
naculum, in its intra-abdominal position, is recog- 
nized, as a somewhat distinct, firm, straight cord, 
about one-eighth of an inch in diameter, some- 
what movable within the peritoneum. The two 
latter are recognizable as hard dense, coiled cords 
or filaments, which are readily grasped beween 
the thumb and fingers, and clearly recognized by 
palpation. 

Securing the Testicle.— These facts we have 
found of the greatest importance in the clinical 
teaching of the operation. It is the keynote in 
our method of instruction. We advance the 
operation to this point, seize the processus vagin- 
alis enclosing the gubernaculum, the vas deferens 
or the tail of the epididymis between the thumb 
and fingers, introduce a long pair of forceps, and 
seize the gubernaculum, epididymis or vas defer- 
ens, still covered by the peritoneum. We then 



24 SPRINGTIME SURGERY 

secure the forceps in this position, with the de- 
sired structure firmly caught, and the beginner 
introduces his hand, palpates all the parts, rup- 
tures the peritoneum, grasps the gubernaculum 
and then the vas deferens, followed by the epi- 
didymis, and completes the operation. 

Reaching and recognizing the internal ring, 
operators divide themselves into two or more 
groups in their further procedure. 

We recommend, in those cases we have just 
mentioned, in which the operator can grasp the 
vas deferens or epididymis outside the ring in the 
processus vaginalis, still covered by the perito- 
neum, that the peritoneal covering be ruptured 
by dragging upon it, the tail of the epididymis 
grasped and drawn out and the testicle itself 
brought out by traction upon the epididymis, thus 
completing the operation without the insertion of 
the hand or even of a finger into the abdominal 
cavity. In some cases, the testicle may not be 
drawn through the narrow ring by traction alone, 
in which instances we insert an index finger, 
dilate the ring, and, exerting traction on the epi- 



CASTRATION OF CRYPTORCHIDS 25 

didymis with the other hand, guide the gland 
through the ring with the introduced finger. 

Should we be unable to grasp the epididymis 
outside the ring, we penetrate the ring with an 
index finger, and, directing it backward, hook the 
index finger over the gubernaculum as it leaves 
the posterior margin of the ring, to immediately 
lose itself in the tail of the epididymis. This is 
grasped, drawn through the ring, and the opera- 
tion then proceeds as before. 

Should the operator fail to locate the ring, he 
needs at least to determine its approximate loca- 
tion, penetrate the muscular wall as near to the 
normal position of the ring as he can determine 
with his index finger, and, palpating the surface 
of the peritoneum, locate and grasp the guberna- 
culum, and eventually the vas deferens. 

Theoretically, should the operator fail to locate 
the testicle by this plan, he should next introduce 
the entire hand into the peritoneal cavity, again 
search for the gubernaculum, the epididymis, and 
especially for the gland itself, and as a final re- 
sort search for the vas deferens about the urethra 
and trace it back to the gland. 



26 SPRINGTIME SURGERY 

Practically, when an operator must insert his 
entire hand into the abdominal cavity in his search 
for the testicle, it is the operator, and not the tes- 
ticle, which is lost, with often a far too poor pros- 
pect of finding himself and recognizing the defi- 
nitely located and attached organ. 

Too many operators, and especially beginners, 
search for, and attempt to identify the testicle, 
without considering the relations to the gland of 
the gubernaculum and vas deferens. Searching 
independently of these for the gland is like a 
shore fisherman on a dark night, who has securely 
hooked and landed a fish in the darkness, and 
starts groping about to find it, instead of follow- 
ing his pole to the line, and thence along the line 
to the hook, where the fish is definitely fixed and 
located. So, in castrating a cryptorchid, the tes- 
ticle need not be "found" in the common mean- 
ing of the word, because it is not "lost," for the 
epididymis and vas deferens are definitely and 
closely moored at the posterior commissure of the 
internal ring by the gubernaculum and at the 
proximal end of the epididymis, securely fixed, is 
the gland itself. 



CASTRATION OF CRYPTORCHIDS 27 

Going back to the course of the operation, when 
the operator has reached the internal ring or its 
immediate vicinity, many operators diverge from 
the technic we have recommended. 

Instead of penetrating the ring, they push 
somewhat upward and forward and penetrate the 
fascia of the small oblique muscle. By this plan, 
the insertion of at least one finger in the abdom- 
inal cavity is necessitated, which, by the direct 
method we have suggested, may be obviated. Be- 
yond this, the operation is identical. 

It is, we believe, erroneously contended by the 
advocates of this plan that prolapse of the abdom- 
inal viscera is thereby obviated. The only cases 
of visceral prolapse from cryptorchid castration 
observed in our clinic have been patients operated 
upon by experienced castrators who were uncom- 
promising devotees to this plan, and applied the 
technic in their operations. 

In the ordinary cryptorchid castration, where 
the testicle is small and flaccid, and where it is 
drawn through the ring by traction on the vas 
deferens and epididymis or the withdrawal is sup- 
plemented by the very slight dilation of the ring 



28 SPRINGTIME SURGERY 

by the insertion of one finger, the danger from 
visceral prolapse is very remote. We have not 
observed the accident under these conditions. 

If the entire hand is forced through the ring, 
admittedly there is danger of prolapse. If the 
entire hand is forced through the fascia of the 
small oblique above and anterior to the internal 
ring or elsewhere in the vicinity, the inevitable 
rent will pass down, and involve, or pass along- 
side the ring and produce a tear essentially iden- 
tical with that caused by forcing the hand directly 
through the ring. 

Pathologic Testicles. — Should the testicle fall 
within the second or third class we have men- 
tioned, and be greatly enlarged, so that it must 
be removed entire, it matters little whether the 
internal ring is enlarged to permit its escape or 
the same sized opening is made in close prox- 
imity to the ring. There results a great rent 
through which visceral prolapse is highly proba- 
ble. Should the operator know in advance that 
he has a testicle of extraordinary size to deal 
with, he should abandon the inguinal route and 
choose the upper flank as the safer and better. 



CASTRATION OF CRYPTORCHIDS 29 

Indeed, under modern surgical technic, the 
flank operation is in any case quite as safe as 
the inguinal, whenever the operator inserts his 
hand into the peritoneal cavity. 

Should the testicle be in a pathologic state, and 
adherent to the intestines or other viscera, the 
flank operation is advisable or even necessary. 
In the one pathologic testicle removed in our 
clinics, the patient being a pig, the testicle was 
firmly adherent to two loops of small intestine. 
It was necessary to draw these out with the 
gland and dissect them away. 

In other animals than the horse, we con- 
stantly prefer the flank operation, except we can 
recognize the epididymis in the inguinal region, 
and draw the gland out by traction. 

Laparotomy. — For the flank operation, the 
patient is secured in lateral recumbency with 
the head end inclined, the flank shaved and dis- 
infected, and an incision is made as for flank 
spaying, of a size to admit one finger or the en- 
tire hand, according to the conditions. 

In small pigs and dogs and cats we have found 
the small wound sufficient. In large boars we 



30 SPRINGTIME SURGERY 

have been forced to make the opening large 
enough to admit the hand. 

Inserting the index finger, or the entire hand, 
the operator frequently recognizes the gland at 
once, lying just by the incision. Otherwise he 
reaches the inguinal ring, grasps the guberna- 
culum, glides along it to the epididymis, and 
thence to the testicle. 

Double Cryptorchids.— In double cryptor- 
chidism in small animals, both testes may be re- 
moved through one incision, or, having opened 
the wrong flank when but one gland is retained, 
he may still complete his operation through the 
erroneous incision. He merely needs pass his in- 
dex finger, or his hand, along the floor of the 
abdomen, across to the opposite inguinal ring, 
grasp the gland, draw it across to the other side 
and out through the incision. 

So, in the cryptorchid horse, if he is a double 
cryptorchid and the operator has inserted his en- 
tire hand in order to secure the first testicle, he 
should not make a second wound, but reach 
across beween the viscera and abdominal floor, 
•seize the second testicle and remove it through 



CASTRATION OF CRYPTORCHIDS 31 

the first wound. Likewise, in operating upon a 
horse with one abdominal testicle, where the 
scrotal testicle has been removed, and the opera- 
tor errs by cutting in upon the wrong side and 
has inserted his hand into the peritoneal cavity, 
he should not make a second wound, but remove 
the testicle through the wound already made. 

After Treatment. — After a cryptorchid tes- 
ticle has been withdrawn from the abdomen, the 
method of severing the cord is usually a minor 
matter. In our first class, which includes proba- 
bly ninety-nine per cent of the cases, and in 
which the gland has been arrested in its develop- 
ment, it is comparatively non-vascular and does 
not bleed. 

The completion of the operation may vary. In 
the flank operation, the abdominal wound is 
naturally sutured. If the inguinal operation has 
been cleanly accomplished with unimportant lac- 
eration of tissues and without danger of visceral 
prolapse, it may well be sutured. If there is 
danger of visceral prolapse or of serious infec- 
tion, antiseptic tampons should be inserted up to 
the internal ring, and held in position by sutures. 



32 SPRINGTIME SURGERY 

By means of large tampons, an enormous rent 
in the abdominal floor may be successfully closed, 
and prolapse obviated. In large rents, the safest 
way to tamponade is to take a broad and ample 
piece of cheesecloth, and spread it with its center 
over the wound. Then take masses of convenient 
size of gauze, cheesecloth or cotton, boiled, im- 
mersed in a disinfectant and pressed dry, and 
push them in to the internal ring, inside the sheet 
of cheesecloth. No matter should it extend a few 
inches into the abdomen, it cannot escape. When 
the wound is well filled, the tampon is secured in 
place by scrotal sutures. 

After twenty-four to forty-eight hours, the 
sutures are to be removed, the packing inside the 
sheet of cheesecloth cautiously withdrawn, fol- 
lowed by the sheet of cheesecloth itself. Blood 
clots are then to be mopped out with antiseptic 
gauze, and, if deemed advisable, a new smaller 
tampon inserted for another day. 

According to the degree of infection, the wound 
may be let alone or mopped out daily with swabs 
of antiseptic gauze, preferably saturated with 
tincture of iodine. The inguinal wound should 



CASTRATION OF CRYPTORCHIDS 33 

not be irrigated, lest the antiseptic be forced into 
the peritoneal cavity. 

Should fever arise, and not be promptly re- 
lieved by local handling of the wound, we recom- 
mend large doses of quinine or potassium iodide, 
usually preferring the former. To a medium 
sized horse we give one to three ounces of quinine 
daily until the fever yields or toxic effects, such 
as trembling or diarrhea appear, when we change 
to potassium iodide. 

Mortality.— This is not well known in crypt- 
orchid castration. In the ninety-one cases in 
our clinic there were included twenty-eight pigs, 
one dog and one cat, among which there were no 
losses. 

Of the sixty-one horses, fifty-six or ninety-two 
per cent recovered, and five animals or eight per 
cent died. These losses are abnormally high. 
Four of the five cases succumbed to infection. 

In the earlier years of our clinic, the opera- 
tions were essentially all by students. In many 
cases, six to ten different students each inserted 
his hand into the inguinal wound and palpated 
the parts. Three of the fatal infections resulted 



34 SPRINGTIME SURGERY 

from this practice. This plan was then aban- 
doned, since which but one fatality has occurred 
from infection, following the operation by a mem- 
ber of the staff. 

Hospital Infection.— In our clinic we have 
had another obstacle to meet. The late Professor 
Williams of Edinburg wrote more than a quarter 
of a century ago advising against the castration 
of horses when the wind was from the east, and 
to avoid operating in any kind of weather in the 
neighborhood of a veterinary college. 

Whatever may be effect of an east wind in 
England, the dangers of operating in a veteri- 
nary college are not to be ignored. Prior to the 
days of antiseptic and aseptic surgery, surgical 
operations on man in hospitals were followed by 
an appalling mortality, but the mortality from 
wound infections in hospitals for man have been 
very largely overcome. 

Veterinary surgery offers a different problem, 
especially in the horse, and the details of efficient 
asepsis and antisepsis in veterinary hospitals is 
not yet satisfactory. A prime difficulty in our 
work is cheapness in the construction and equip- 



CASTRATION OF CRYPTORCHIDS 35 

ment of our veterinary hospitals, with limited 
opportunity for efficient disinfection. 

From the beginning of our clinic in 1896 up to 
a recent date, we have noted an increased ten- 
dency toward serious infections, from the open- 
ing of the clinic in the autumn to its close in June. 
The hospital and operating room were then va- 
cant and open for the summer months. In other 
words, the presence in the hospital and in the 
operating room of cases of fistulous withers, poll- 
evil and other chronic, profusely suppurating 
maladies so befouled the establishment that viru- 
lent infection abounded. Our cryptorchid cas- 
trations came almost wholly toward the close of 
our school year, when infection of our hospital 
had apparently reached its highest virulence. 
This we have fought so energetically that we now 
believe we can perform most operations in our 
hospital with greater safety than outside, and be- 
lieve we can castrate as safely as anywhere. 
Neither do we observe increased infection as the 
year advances. In fact, we last year extended our 
clinic to cover the entire year, and are still able 
to keep wound infection under satsif actory control. 



36 SPRINGTIME SURGERY 

Sources of Infection.— Aside from the disin- 
fection of the instrument and of the hands, arms 
and clothing of the operator, there are other neg- 
lected sources of infection which the veterina- 
rian should recognize. 

Our casting apparatus constitutes a highly 
dangerous bearer of virulent infections, and the 
body surface of the animal, with its massive coat 
of hair, which it is perhaps shedding, affords 
ample opportunity for the entrance of infection 
into the wounds. We should devise better means 
for obviating these. 

Aside from infection, the mortality from crypt- 
orchid castration is well nigh negligible. Of 
course, casting accidents may occur, and some 
losses have taken place from intestinal prolapse. 
The latter, can and should, always be obviated. 

Complications.— Among our five deaths, one 
was due to an accident based upon an error. We 
opened the patient on the wrong side, recognized 
the vas deferens of the testicle which had been 
removed, but, before we were aware, had made a 
rent in its peritoneal fold. We reached across 
to the opposite side, grasped the testicle and re- 



CASTRATION OF CRYPTORCHIDS 37 

moved it through the wound. A loop of the small 
intestine dropped through the peritoneal rent be- 
hind the vas deferens of the testicle which had 
been removed at a prior date, the intestine be- 
came strangulated and the patient succumbed. 
Had such a result been anticipated or thought of 
as a possibility all danger could have been obvi- 
ated, after the rent had been made, by rupturing 
the vas deferens, thus leaving no place for the 
incarceration of the viscera. 

So with other complications which may arise. 
The operator should preserve his equanimity, 
and, in cases of error or unexpected complica- 
tions, promptly and coolly meet the conditions. 
To this end, the operator needs be fully prepared 
for emergencies, have the surroundings in all es- 
sentials suitable, have abundant help at hand, 
and, beyond all else, needs be in good physical 
condition, free from fatigue of body or mind. 

In the one fatal error we have recorded, the 
difficulty was largely referable to the fact that 
the writer was ill, and should, by all rules of pro- 
fessional action, have been in bed instead of at 
the operating table. Good surgical work requires 



38 SPRINGTIME SURGERY 

vigor of both mind and body, and we are forced 
to see this if we undertake an operation when 
we are unfit, and then meet with complications. 



Practical Methods of 
Cryptorchidectomy* 

By Charles Frazier, B. Sc, M. D. V., Professor of 

Pathology and Bacteriology and Dean of the 

McKillip Veterinary College, Chicago 

It is my purpose in this article to outline a 
technic which has given uniform success in my 
hands, one that is based on a thorough study of 
the anatomical and surgical conditions met, and 
one which I am sure any one can follow who has 
any skill whatsoever. I want at this point to em- 
phasize the fact that the operation, as practically 
carried out, is a simple one. 

Preparation of the Patient.- This can be 
summarized in one statement. Have the patient's 
bowels moderately full of ingesta and absolutely 
free from the irritability produced by cathartics, 
change of food and emptiness. Do not give 



♦Reprinted from the American Journal of Veterinary Medicine, 
May, 1911. 



40 SPRINGTIME SURGERY 

cathartics of any kind; do not starve the patient 
and do not upset the intestinal canal by a radical 
change of food. 

A bowel that is moderately distended with in- 
gesta, free from all forms of irritation, in nor- 
mal and perfect physical and physiological con- 
dition, is the one that is not going to be upset by 
any amount of clean manipulation in the abdo- 
men and surely is not the one to prolapse most 
frequently. Peritoneal irritability explains in a 
large degree prolapses of the omentum. The 
omentum has been aptly called the "policeman of 
the belly," searching out, as it does, localized 
peritoneal disturbances, and through some power 
of its own going to such areas and attempting to 
cover them over by adhesions, where there is in- 
jury to or loss of the peritoneal tissue. Thus it is 
apt to wander down the inguinal canal at inop- 
portune times. 

Rectal Examination. — Prior to the operation 
this is not to be thought of as a routine practice. 
In animals that have had one testicle removed and 
a diagnosis as to the side is wanted, there is a 
better way of proceeding than by rectal examina- 



PRACTICAL CRYPTORCHID CASTRATION 41 

tion, and further, in such cases, a rectal exami- 
nation by the best operators gives no positive re- 
sults and frequently leads to harmful procedures. 
The question of the side upon which to operate is 
not, except very rarely, a difficult one to decide. 
The answer is obvious if the animal has never 
been operated upon or if one testicle has been 
removed and there is but one scar and that 
clearly upon one side of the scrotum. A diagno- 
sis is to be made, not at all upon the history the 
owner gives, but upon one's own findings. This 
examination is to be made after the animal is 
cast, and consequently will be considered later. 

Disinfection. — Antiseptic applications to the 
scrotum, prepuce and thighs, some hours preced- 
ing the operation, have no place in the technic. 
Theoretically they may be defended, but practi- 
cally they cannot. 

The total pre-operative treatment therefore 
consists of placing the patient upon a moderate 
diet for twenty-four to forty-eight hours preced- 
ing the operation. Nothing else is necessary, and 
other processes are not only superfluous but in- 
convenient to the general practitioner. 



42 SPRINGTIME SURGERY 

The operation is carried out in as simple a rou- 
tine method as possible, keeping in mind at all 
times these three dangers, viz., casting accidents, 
prolapse of the bowels and infection. 

Equipment. — The necessary equipment for the 
operation consists of the following: A casting 
outfit, scalpel, emasculator and ecraseur, operat- 
ing sheets, green soap, tablets of bichloride of 
mercury, finger-nail brush, sterile, dry gauze 
packs in a sterile container, a trocar, a one-quart 
bottle, and a large needle and suturing material, 
preferably linen tape one-fourth inch broad. 

Casting. — For the sake of uniformity of 
method all patients should be operated upon in 
the casting harness. The operating table offers 
no advantages and is not always at hand. The 
casting harness to use is the one that you are fa- 
miliar with, providing you are skilled in its use 
and can adapt it to the operation. Properly con- 
fining the animal is a larger question than the 
actual operation, since upon it depends, not only 
one's success in satisfactorily performing the 
operation, but also the danger of casting acci- 
dents, and to a degree the dangers of prolapse of 



PRACTICAL CRYPTORCHID CASTRATION 43 

the bowels and of peritoneal infection. The re- 
quirements of such a harness are: 

1. It must hold the animal firmly so that no 
change of position is possible. 

2. All four legs and especially the hind legs 
must be fully flexed upon themselves and held so 
firmly that change of position is impossible. 

3. The hind legs must be held by the harness 
in a widely abducted position with the legs so 
flexed that the hoof is just slightly in advance of 
the stifle. 

I cannot emphasize too strongly the impor- 
tance of this latter requirement. One should 
study and practice the art of casting until he is 
perfect in it; too many failures in surgical opera- 
tions are the direct result of bunglesome and im- 
perfect tying. 

The operating sheets mentioned in the list of 
articles needed for the operation have served me 
very valuable purposes and saved me much time 
and annoyance during operation. They are 
merely muslin sheets one and one-half yards 
square, some of which have central oval openings 
seven inches long by one inch wide. 



44 SPRINGTIME SURGERY 

Plan of Procedure.— The details of conduct- 
ing an operation in the country are about as fol- 
lows : Upon arriving at the place of operation a 
spot for casting is selected. There are no par- 
ticular specifications regarding a casting site ex- 
cept that it be level and of sufficient size. A grass 
plot is best, although not indispensable. A clean 
operation can be done anywhere, but more care 
is required in dirty, dusty surroundings. When 
the casting site is selected, the owner is directed 
to procure a pail of warm water and a basin and 
to have the patient brought out. While this is be- 
ing done the operator prepares his equipment for 
the operation. The scalpel, emasculator, ecras- 
eur and needle, threaded with a piece of tape fif- 
teen inches long, all previously sterilized by boil- 
ing, are laid out on a clean (if not sterile) towel 
on some improvised table, as a board, box or 
medicine case. The quart bottle is filled with 
water and to it is added enough mercuric chloride 
tablets to make a solution of 1-1,000 or even 
1-500. The can of sterile gauze, the nail brush, 
soap and operating sheets are placed conveniently 
near. The horse is then cast and tied, the opera- 



PRACTICAL CRYPTORCHID CASTRATION 45 

tor (who, in country practice, must do the tying 
as a rule), wearing gloves to protect his hands to 
a certain degree from contamination. Chloro- 
form is not used. 

After the animal has been cast and properly 
tied for the operation, is the time to make the 
examination if a diagnosis of side is necessary. 
Of course, this is a question that needs attention 
only when one testicle has been removed and 
there is a scar on both sides of the scrotum. The 
side from which the testicle has been removed 
can be told in all cases by the presence of the 
stump of the cord or the spermatic fascia in the 
scrotum or inguinal canal of that side except in 
cases where the testicle removed was an abdom- 
inal testicle, when there will be no stump pres- 
ent. These cases are rarely met with, and a posi- 
tive diagnosis of the side can be made only by 
abdominal exploration during the operation. 
Ordinarily when one testicle is removed it is a 
descended testicle and its removal leaves a stump 
in the scrotum and inguinal canal that can be 
easily determined by careful examination. The 
history by the owner is usually of no value and 



46 SPRINGTIME SURGERY 

the character of the scrotal scar means nothing. 
As the operation proceeds the operator further 
satisfies himself as to his diagnosis as will be 
mentioned hereafter. 

A determination of the side having been made, 
the patient is placed in a position half way be- 
tween a lateral and dorsal decubitus, with the 
operative field uppermost. This is usually best 
accomplished by placing the horse in a lateral po- 
sition and then by means of a rope noose on the 
upper hock have an assistant apply a little trac- 
tion as if to roll the patient over on its back. 
This not only places the patient in a good position 
but abducts the upper limb and improves the con- 
dition of the operative field and thus facilitates 
the operation. 

Cleansing the Field of Operation. — The next 
question for the operator to concern himself with 
is that of the aseptic preparation of the opera- 
tive field. An appreciative mind will understand 
that all the dangers of this, as well as any other 
surgical operation, are increased by prolonging 
the period of the operation. Consequently the 
period from the time the casting harness is put 



PRACTICAL CRYPTORCHID CASTRATION 47 

on the patient until the animal is again up and 
in its stall should be as short as is consistent with 
good surgical principles. The process of asepti- 
cizing the operative field is one in which much 
time can be saved by a study of the conditions. 
Excessive scrubbing and cleansing is not only 
without results of value but often productive of 
conditions exactly opposite to those at the pro- 
duction of which the process is aimed. Absolute 
asepsis can not be obtained in veterinary practice 
except at a great outlay of expense and trouble 
that is not justifiable. In cryptorchid operations 
relative asepsis is all that is needed for success- 
ful work. Peritoneal infection and scrotal infec- 
tion are the least of my fears when operating. A 
good rule is to be as aseptic as the conditions 
will allow without endangering your patient by a 
prolonged, bunglesome technic (and without los- 
ing money on the operation) . 

The method that I follow in country work in 
preparing the operative field requires from two to 
five minutes, the length of time consumed depend- 
ing on whether it is done by myself or by an as- 
sistant while I am scrubbing my hands. The 



48 SPRINGTIME SURGERY 

process consists of scrubbing the scrotal area 
only, with green soap and water until it is free 
from visible dirt. The upper foot, leg and thigh 
are then encased in an operating sheet which is 
clean (not sterile) and which is applied in a few 
seconds of time, being made so as to fit the parts 
and supplied with proper means of attachments. 
This protects the field against serious contamina- 
tion from that source. The lower leg may be 
covered in a like manner, but this is rarely neces- 
sary. The soap and water scrubbing is confined 
to a small area of the scrotum at the point where 
the incision is to be made. This is important. 
Uncleaned areas near the field of operation are 
covered by a sheet and are just as removed from 
the operation as if they were on another animal. 

The soap and water scrubbing over, and the 
two hind legs encased in protective sheets, the 
operator proceeds to scrub his hands and arms, 
paying particular attention to the hand that is to 
be inserted into the belly wall. Relative asepsis 
only is aimed at by a one- to three-minute scrub- 
bing of the hands with the brush and green soap, 
followed by a short scrub in the bichloride solu- 



PRACTICAL CRYPTORCHID CASTRATION 49 

tion. This being done, the operator with clean 
hands gives a short final scrub to the operative 
field which is then subjected to an application of 
the bichloride solution and an operative sheet 
spread over the belly and scrotal region so that 
the opening comes over the line where the in- 
cision is to be made. The area of the incision is 
then painted with tincture of iodine, a quick, 
practical and efficient means of producing sur- 
face asepsis. 

The Incision. — The routes by which the ab- 
dominal cavity is entered by cryptorchid cas- 
trators may be clased into three general groups, 
viz.: 

1. Through the inguinal canal. 

2. Directly through the belly wall in the neigh- 
borhood of the internal ring. 

3. Directly through the belly wall in the upper 
flank region. 

There are a number of varieties of each group, 
each of the numerous operators varying the 
process to suit his individual taste. 

The method that I prefer is the inguinal canal 
route. The technic of entering the abdominal 



50 SPRINGTIME SURGERY 

cavity by this route is as follows: An incision, 
five or six inches long, is made through the 
scrotum parallel with and one or two inches 
from the median raphe. This incision is carried 
through the skin and dartos into the scrotal sac. 
When this is done the scalpel is laid aside and the 
remainder of the process is carried out entirely 
by blunt dissection with the fingers. The scro- 
tum is found to contain considerable areolar 
fascia and a mass of blood and lymph vessels. 
No attention is paid to these ; they are pulled this 
way or that, until an opening is made through 
them down to the external ring of the inguinal 
canal, which is but an oval slit through the apo- 
neurosis of the external oblique muscle, large 
enough to freely to admit the operator's hand. 
This muscle is located just in front of the pubis 
and at the side of the prepubian tendon, land- 
marks that are easily determined. The exposure 
of this ring and the introduction of the hand into 
it is a matter of no difficulty. The fingers of 
both hands are used in the dissection up to this 
point. Now but one hand is required to finish 
the opening. 



PRACTICAL CRYPTORCHID CASTRATION 51 

Traversing the Inguinal Canal.— The oper- 
ator places himself so that he is facing the field 
of operation and uses the right hand if it is the 
left testicle that is retained and vice versa. The 
hand used is inserted through the scrotal incision 
and through the external inguinal ring into the 
inguinal canal. The fingers of the hand should 
be bunched and directed toward the internal in- 
guinal ring, to which they are gradually forced, 
separating the muscular belly of the internal ob- 
lique muscle, which lies on the palm or side of 
the hand, from the aponeurosis of the external 
oblique muscle and Poupart's ligament which lies 
on the back of the hand. While the introduc- 
tion of the hand through the external ring and 
into the canal is always an easy matter, the pass- 
ing of the hand up the canal in the proper direc- 
tion and the locating of the internal ring is, to the 
uninitiated, usually attended with more or less 
difficulty. The direction to go is deep into the 
fold of the groin, keeping back against Poupart's 
ligament and the thigh muscles. 

Most beginners, I have found, have trouble in 
locating the internal ring because of two chief 



52 SPKINGTIME SURGERY 

mistakes. One is in keeping too far forward and 
the other is in being afraid to insert the hand far 
enough up the canal. I therefore try to empha- 
size the importance of going high up into the 
groin and keeping back against the thigh when 
forcing the hand up the canal. 

Locating the Internal Inguinal Ring. — 
After the canal has been traversed by the hand 
the selection of a spot for the opening into the 
belly is the next thing of importance. There are 
four places that may be used and are used by 
various operators. 

1. Through the internal ring. 

2. Below the internal ring. 

3. In front of the internal ring. 

4. Above the internal ring. 

No matter what position is selected for the 
opening, the wise operator will first locate the in- 
ternal inguinal ring as a starting point. This 
ring represents the upper end of the inguinal 
canal. After the hand has been forced up the 
canal to a point beyond the upper border of the 
internal oblique muscle the operator finds that 
only a relatively thin structure separates his 



PRACTICAL CRYPTORCHID CASTRATION 53 

fingers from the abdominal viscera, which can be 
felt more or less clearly. This thin membrane 
consists of two chief parts or layers. These are, 
first, the general fascial lining of the abdomen, 
which is often designated as the transversalis 
fascia and is spread out as a lining of the entire 
abdomen and pelvis, and, second, the peritoneum. 
In the animal with the testicle undescended the 
internal ring is not an opening or a slit as it is 
sometimes said to be but it is merely a thinned- 
out area of the above mentioned transver- 
salis fascia, this area being bordered and limited 
in front and below by an arched band of con- 
nective tissue which, after the descent of the 
testicle through the fascia at this point, forms 
the true ring. The upper and posterior borders 
of the thinned-out area of the fascia have no 
limiting band of fibers and, as a matter of fact, 
in the ridgling the area is not defined at all in 
these two directions. (The anatomical facts may 
be beautifully demonstrated by a dissection of a 
seven or eight-months' fetus.) Consequently, the 
operator, in searching for the internal ring, does 
not feel for a slit-like opening, but searches for a 



54 SPRINGTIME SURGERY 

thin portion of the membrane which presents an 
arched, limiting band of fibers in front and below. 
This band may often be demonstrated externally 
by deep palpation in the middle of the fold of the 
groin. Its determination with the hand in the 
canal is a matter of little difficulty. 

In a great many cryptorchids the testicle or 
epididymis has partially descended through this 
area and one may find a condition of affairs vary- 
ing from a mere looseness of the fascia in the 
area to a finger-like projection of it containing 
the tail or more of the epididymis. Ofttimes the 
tail of the epididymis has descended through this 
area and the band of fibers, which normally con- 
tracts after natural descent of the testicle, has 
contracted down, constricting the testicular struc- 
tures so that the globus minor of the testicle is 
below the band and the globus major and the 
body of the testicle is above and within the ab- 
dominal cavity and unable to descend further. 

The internal ring, or better, this area in the 
transversalis fascia, lies just anterior to the shaft 
of the ilium at about its middle and the fascia just 
behind the ring is reflected backward into the 



PRACTICAL CRYPTORCHID CASTRATION 55 

pelvis where it becomes the pelvic fascia and 
where it is more or less firmly anchored. I, there- 
fore, often consider the internal ring in the ridg- 
ling as being a thin area in the transversalis 
fascia bordered anteriorly and inferiorly by this 
arched band of fibers and posteriorly and supe- 
riorly by the shaft of the ilium, around which the 
fascia is reflected into the pelvis and to which it is 
more or less intimately attached. This area as de- 
fined is just about large enough to admit a hand 
with ease. The recognition and protection of the 
integrity of the borders of this internal ring is a 
matter of much importance in the operation. 

In the process of passing the hand up the canal 
and in locating the internal ring, the operator 
may inform himself concerning a number of 
things. If it is a second operation he may ob- 
serve by the scar tissue how far up the inguinal 
canal the previous operator went and where and 
whether or not he entered the abdominal cavity. 
If a diagnosis of side has been made, the operator 
while in the canal confirms it by the absence of 
the cord stump in the canal. One, of course, ob- 
serves whether or not the testicle or any part of 



56 SPRINGTIME SURGERY 

it has descended into the canal, producing a com- 
plete or partial flanker. If it is a complete 
flanker, all of the testicle having passed through 
the inner ring, the case is handled as a plain colt. 
If only a part of the testicle is descended, ignore 
the condition and operate as a ridgling, making 
the opening at the usual point. In the partially- 
descended testicle it is almost always the tail of 
the epididymis that has descended and the ring 
has contracted down around it so that the testicle 
cannot pass through and usually cannot be pulled 
through with safety to the ring. I have found 
that these are best handled by passing up along 
the side of the descended tail and, making the 
opening at the usual place, pulling the descended 
portion back into the belly and out the opening. 
Opening the Peritoneal Cavity.— I have 
satisfied myself that the best place to open into 
the peritoneal cavity from the upper end of the 
canal is at a point just in front of the shaft of 
the ilium, at the upper part of the internal in- 
guinal ring. In operating, I locate the internal 
ring and then proceed upward and somewhat 
backward until I come to the point where the 



PRACTICAL CRYPTORCHID CASTRATION 57 

fascia passes back into the pelvis and here I 
thrust two fingers through into the belly cavity. 
In making the opening one must remember that 
there are two layers to go through, the fascia and 
the peritoneum. Sometimes the peritoneum 
pushes ahead of the fingers and strips off of the 
wall and requires a special effort to puncture. 
This is particularly true in older horses and in 
second operations where age and inflammation 
have thickened and toughened the peritoneum. 
It is also more apt to occur in the horses with 
empty intestinal tracts. 

Before leaving the subject of the opening into 
the belly I wish to emphasize one thing. Preserve 
the integrity of the band of fibers that bounds 
the internal ring anteriorly and inferiorly. This 
band is not easily torn, but in the use of force in 
extracting the testicle or in other manipulations, 
see to it that no great tension is thrown upon it. 
So long as this band is intact the rent in the fascia 
is limited by it. If it is torn across, any increase 
in the intra-abdominal pressure may cause it to 
tear farther down and the protection against pro- 
lapse of the bowel is lost. In all cases where an 



58 SPRINGTIME SURGERY 

enlargement of the opening is necessary make it 
upward and backward ; never by use of the knife 
or other means enlarge the opening in the other 
directions. If one finds a testicle so large that 
it cannot be forced out through this area with- 
out endangering this band of fibers, then it is too 
large a testicle to be removed through the in- 
guinal region. This is too dependent a portion of 
the belly wall for large openings at any point. 
My method of handling such cases, which fortu- 
nately are very rare, is, if the testicle cannot be 
forced through the opening after all means of 
reducing its size (tapping of cysts, etc.) have 
failed, to discontinue the operation at this point, 
allow the inguinal wound to heal, and after three 
or four weeks remove the testicle through a lapa- 
rotomy in the upper flank region. 

Locating the Testicle.— We will presume 
that the operator has traversed the inguinal canal, 
located the internal ring area, and advanced be- 
yond this area in a direction upward and backward 
until he finds his fingers against the pelvic inlet 
at the middle of the shaft of the ilium, and at this 
point has thrust two fingers through the medium 



PRACTICAL CRYPTORCHID CASTRATION 59 

separating his hand from the peritoneal cavity. 
With the same movement by which the opening is 
made, it should be enlarged to a size sufficient to 
admit three fingers, by the spreading of the two 
fingers that have been used. If this is carried 
out quickly and if the rent made is held open by 
the two fingers and at the same time the hand is 
retracted somewhat so as to make an empty space 
in the upper end of the canal, the testicle or some 
part of its cord will be forced out into the palm 
of the hand. This will occur in a very large per- 
centage of the cases, in all that are not compli- 
cated by adhesions or grossly pathological testicles. 

This little process of "coaxing" the testicle out 
is possible only when the animal is properly tied, 
when the opening is properly located, when the 
abdomen is not too empty, and there is an intra- 
abdominal pressure, and when the animal is not 
anesthetized. To the beginner, with some doubt 
as to his ability, there is no more pleasant sensa- 
tion than that produced by the testicle forcing 
itself upon him and down the canal. 

If the "coaxing" process fails in its purpose 
after a few seconds' trial, then the fingers explore 



60 SPRINGTIME SURGERY 

the region inside the opening. The cord struc- 
tures pass from above downward in close juxta- 
position to the opening. They are attached to the 
belly wall near the opening and consequently can- 
not get far away. More often they are right be- 
neath the finger tips, very often they are in front 
of the opening and less frequently they are be- 
hind the opening. In the past six years with a 
large series of cases it has not been necessary for 
me to introduce the entire hand into the abdomen 
to locate the testicular structures. I have, in 
several cases, introduced the hand into the abdo- 
men for the purpose of examining pathological 
and enlarged testicles, and for overcoming cer- 
tain conditions in the removal of testicles. 

No Search Necessary. — With due attention to 
the entrance into the abdomen, search for the tes- 
ticle is eliminated. It is right at the finger tips 
when they are introduced. The only thing that 
is necessary is to be able to recognize the differ- 
ence, by sense of touch, between the testicular 
structures and loops of bowel. This should not be 
difficult, but I notice that some are unable to do 
it with certainty. Examination of the structures 



PRACTICAL CRYPTORCHID CASTRATION 61 

that present themselves to the fingers will soon 
reward the operator by a discovery of the cord or 
testicular parts. If in doubt, bring the structure 
down the canal and examine it by the sense of 
sight. Remember that some of the structures 
wanted are just inside the opening and that a 
little patience will reveal them. 

The time-worn quack story about going up to 
the diaphragm and the spine to find the testicle 
is to be forgotten. It is for the edification of the 
laity only. I have never found it of value to use 
the gubernaculum as a guide in finding the testi- 
cle. Some parts of the epididymis, cord or testicle 
presents itself invariably upon entering the peri- 
toneal cavity, and rarely indeed is the slightest 
search required. 

Removal of the Testicle.— The testicular 
structures having been located and recognized, 
they are brought down the canal and removed. 
This is usually an easy matter. The testicle and 
epididymis are drawn down by the fingers until 
an emasculator can be applied. It is well to have 
at hand an ecraseur to use in case the cord struc- 
tures are so short that the testicle cannot be 



62 SPRINGTIME SURGERY 

drawn far enough down to use the emasculator. 
One can use an ecraseur in all cases and dispense 
with the emasculator altogether, but I have found 
that an emasculator can be used in about ninety 
per cent of the cases and, being a much quicker 
and easier method than the other, one is justified 
in carrying both instruments in his equipment. In 
cutting off the testicle see that the three parts are 
removed, viz., body of the testicle, head of the 
epididymis and tail of the epididymis. These 
three parts are often far separated in a retained 
testicle and it is well to see that they are all in- 
cluded in the parts removed. 

11 Cutting 'Em Proud' ' a Fake.— I might say 
in this connection, that the old idea that leaving 
on the stump of the cord, a part of the epididymis 
would influence the nervous and physical develop- 
ment of the animal and give to it the characteris- 
tics of a stallion cannot be substantiated. The 
influence that the testicles have upon the physi- 
cal and temperamental development of the ani- 
mal depends upon an internal secretion elabo- 
rated by these organs, absorbed into the blood 
and lymph channels and exerting its influence, in 



PRACTICAL CRYPTORCHID CASTRATION 63 

harmonious relation to other internal secretions, 
upon the activity and metabolism of the various 
systems of organs. This internal secretion is 
elaborated largely if not entirely by groups of 
epithelial cells embedded in the stroma of the 
body of the testicle and not found in any part of 
the epididymis. I have satisfied myself on the 
proposition by leaving the epididymis in a few 
castrated animals with negative effect. 

Complications That May Exist. — Occasion- 
ally more or less difficulty is met with in bringing 
the testicle through the opening and down the 
canal. When one has located the cord and moder- 
ate traction on it fails to bring the testicle into 
the canal it is due to one of the following causes : 

1. An enlarged testicle, which hangs heavily 
over the border of the ring. 

2. A partially descended testicle, the tail of 
which is gripped by the contracted ring (this, of 
course, should have been recognized previously). 

3. Adhesions of the testicle to the abdominal 
wall at some point. 

In the presence of any of these complications 
the first thing to do is to examine and diagnose 



64 SPRINGTIME SURGERY 

the complicating conditions. The cord which has 
been grasped and pulled down into the canal is 
held by the fingers of the free hand or by a pair 
of heavy forceps. The hand in the canal is then 
passed up along the cord and with the fingers, or 
if need be the entire hand, in the peritoneal cavity 
the structures are examined, remembering that 
the testicle is attached to the lower end of the 
doubled cord in the inguinal canal and that by fol- 
lowing this out the testicle will be reached. Oc- 
casionally it may be best to turn the cord loose, 
especially if the entire hand is inserted into the 
abdomen. Cases of these kinds are fortunately 
rare and when one is met a little patience on the 
part of the operator will allow him to make a 
positive diagnosis of the complicating condition. 

The treatment of adherent testicles is obvious. 
The adhesions are broken up and the testicle 
brought down. In the cases in which the tail of 
the epididymis has descended through the internal 
ring and is in the grasp of the ring the treatment 
consists in pulling it back into the belly and out 
through the opening and down the canal. The 
handling of enlarged testicles is a subject of more 



PRACTICAL CRYPTORCHID CASTRATION 65 

importance. From a practical standpoint the en- 
larged testicles may be divided into two classes, 
viz., cystic and solid, the former admitting of a 
reduction in size by tapping. Upon the discovery 
of an enlarged testicle during the progress of the 
operation the operator settles two questions in his 
mind. First, is the testicle small enough to pass 
out through the ring safely? This, however, 
varies greatly in different cases and the operator 
is the judge of the possibilities in a given case. 
Second, is the testicle cystic? If so, it is tapped 
through the inguinal canal with a long trocar. 
The technic is as follows: An assistant, not 
necessarily but best a skilled assistant, empties 
the rectum of the patient and inserts the hand into 
the same as far forward as possible. By the direc- 
tions and assistance of the operator, the assistant, 
by rectal manipulation, pushes the testicle up 
against the internal ring and holds it there firmly 
by pressure from behind. The operator then in- 
serts a trocar up the canal, and it is usually an 
easy matter to draw off the cystic fluid. The 
rectal manipulation of an assistant is of great 
value also in the withdrawal of a large testicle 



66 SPRINGTIME SURGERY 

through the internal ring. Where the mass is so 
large that there is difficulty and danger in pulling 
it through the ring by traction on the cord alone, 
then an assistant working through the rectum can 
be of great assistance. He can force the testicle 
through the ring in a manner that is much safer 
than that of pulling it through and much larger 
testicles can be removed safely by such means 
than can be removed by pulling alone. 

Laparotomy May Be Necessary.— If the ex- 
amination or repeated trials demonstrates the 
fact that the testicle is too large to be safely re- 
moved through the inguinal canal and its size can- 
not be reduced by tapping or other means, then 
there is but one thing to do. Discontinue the at- 
tempts at removal, dress the wound, allow the 
patient to rise, and wait a couple of weeks until 
the inguinal wound is healed and then take the 
testicle out through a laparotomy opening in the 
upper flank. One might argue at this point that 
a rectal exploration preceding the attempted oper- 
ation would have made unnecessary the exposure 
of the patient to the dangers attending the'abdom- 
inal exploration, but this is not true. I have yet 



PRACTICAL CRYPTORCHID CASTRATION 67 

to see the man who is positive enough in his find- 
ings by rectal examination to gamble on his diag- 
nosis. Abdominal exploration is certain in its re- 
sults and the dangers are practically nil when one 
practices good technic. 

The tapping of cystic testicles is not attended 
by any danger. The contents of these cysts is 
sterile and leakage into the peritoneal cavity is of 
no consequence. I remember of but one report in 
the literature of an infected testicular cyst. They 
are so rare as to be of negligible import. 

Wound Treatment -After the testicle has been 
disposed of. The dressing of the wound is to be 
undertaken. This is simple. It is best explained 
by emphasizing a few things that it is important 
not to do. 

Do not, at any time, introduce any kind of anti- 
septic or aseptic fluids into the inguinal canal. 
From the time the operator takes his scalpel to 
make the scrotal incision until the operation is 
completed, clean methods are important, but anti- 
septic solutions within the abdomen are tabooed. 

Do not at the end of the operation remove the 
blood from the wound. There is no hemorrhage 



68 SPRINGTIME SURGERY 

of any consequence and it is seldom that one needs 
to ligate a bleeding point. The only hemorrhage 
that one can have is from the vessels of the dartos 
and they are small. Hemorrhages from the stump 
of the cord is practically unimportant except oc- 
casionally in pathological testes, in which case one 
can ligate before cutting off with the crushing in- 
struments. 

Do not introduce a pack of any size into the 
inguinal canal. I believe that any operation that 
requires the canal to be packed is, generally speak- 
ing, a failure. Operating by the foregoing 
method, heeding the warnings that have been 
given, one will never have need for the pack. 

The opening into the belly that is described in 
the foregoing is a self -protecting one against es- 
cape of the viscera. Of course, it is possible for 
a loop of bowel to come down, but I have never 
had such to occur. A dressing of the wound 
that is to be recommended is as follows : 

As soon as the testicle is disposed of a small 
pack of dry sterile gauze is placed in the scrotum 
and the scrotal wound is sutured by a continuous 
suture of the linen tape. Its chief purpose is to 



PRACTICAL CRYPTORCHID CASTRATION 69 

absorb by capillarity, the juices collecting in the 
wound and when removed, twenty-four hours 
later, to leave an open, well-drained wound. In 
suturing the wound it is well to leave the ends of 
the sutures long so that they hang down a dis- 
tance of four or five inches. This facilitates their 
removal. The owner or caretaker of the patient, 
if in country work, is shown how the stitches are 
put in and how and when to remove them. 

Accidents Subsequent to Operation.- The 
release of the patient from the casting harness 
should be conducted with care. The period of re- 
lease and until patient gains his feet, if attended 
by struggling, is a time when intestines may be 
forced down into the canal. Consequently this 
is to be considered one of the danger periods. The 
ropes must be removed with dispatch and removed 
quietly so as not to excite the patient. When un- 
tied the patient is given assistance in arising so 
that awkward movements, as wide abduction of 
the hind limbs, will not occur to open up the canal 
and tempt intestinal protrusion. I believe that 
the only danger of intestinal prolapse with the 
above operation is when the animal, carelessly 



70 SPRINGTIME SURGERY 

forced to arise by the operator, awkwardly stag- 
gers about with the hind limbs widely apart and 
the belly muscles tensely contracted in its attempt 
to gain a balance. Therefore, care at this time is 
important. 

If the intestines should prolapse at this time (a 
thing which I have not seen with this operation, 
but have experienced in using other methods), 
the scrotal pack and sutures will protect against 
all dangerous conditions until they can be re- 
turned. With the internal ring intact, as soon as 
the animal is squarely on its feet there will be a 
tendency for the intestines to return to the belly. 
This may be assisted if necessary in two ways. 
One can use a little pressure upward on the in- 
guinal region or he can insert the hand into the 
rectum and by sweeping it across the region of the 
internal ring, pull the intestines back into the 
belly. 

After-Care.— The after treatment of the pa- 
tient is simple. As soon as he is released he is 
given a little water and is tied in a comfortable 
place and in such a manner that he cannot lie 
down. He is allowed a moderate ration of food 



PRACTICAL CRYPTORCHID CASTRATION 71 

and is kept quiet for twenty-four hours. At the 
end of this time, in the uncomplicated cases, the 
caretaker removes the sutures and pack after 
which the patient is treated as he would be had 
he been a straight colt. He is allowed to run at 
large or is given plenty of exercise and a full 
diet. I have never found irrigation or other 
treatment of the wound necessary. He is kept 
standing only twenty-four hours. 

In Conclusion. — We may say the uncompli- 
cated case requires but a short time for castra- 
tion and is but little affected by it. These cases 
will feed immediately upon being tied in their 
stalls and there are no post-operative complica- 
tions of any sort to deal with. Swellings of the 
scrotum and prepuce is usually less in evidence 
than in straight colts as the pack produces a bet- 
ter draining wound. Peritonitis is an evidence of 
inexcusable errors and carelessness in operating. 
Double cryptorchids are quite frequently met 
with. They are handled as the single ones. Re- 
moval of the two testicles through a single open- 
ing is rarely advisable. Remembering that prac- 
tically all cryptorchid testicles may be removed 



72 SPRINGTIME SURGERY 

with but one or two fingers inserted into the peri- 
toneal cavity, one can see that the opening up of 
the second inguinal canal would be far less in- 
jurious than inserting the whole hand through 
the belly wall in the attempt to bring across the 
second testicle. It is best to make a double opera- 
tion, but remove both testicles at one casting. 

The operation where entrance to the peritoneal 
cavity is made by an incision directly through the 
belly wall in the neighborhood of the internal ring 
is used by several operators and with success. I 
have not found it as satisfactory, from a number 
of standpoints, as the inguinal-canal route. 

An operation that one will very infrequently 
have occasion to use is that in which the peri- 
toneal cavity is reached through its triangle of 
the upper flank. This operation is the one of 
election when a large testicle is to be removed. 
The opening is made at a point where it can be 
completely controlled from a surgical standpoint, 
it can be closed and protected and it is where 
danger of intestinal prclapse is absent. Opening 
the belly cavity in this region is a safe procedure 
under even moderate aseptic conditions. I have 



PRACTICAL CRYPTORCHID CASTRATION 73 

had occasion to use it in cryptorchids and have 
repeatedly used it in spaying mares. The time- 
honored pronunciamento, that it is fatal to 
open the abdominal cavity of the horse, belongs 
to the pre-Listerian era and has little bearing 
on modern aseptic surgery. Successful lapa- 
rotomy in the equine depends merely upon con- 
trolling the concomitant infection of the peri- 
toneum, aside from which, it presents no serious 
difficulty. 

Young patients are much more satisfactory to 
operate upon than older ones. One should, in 
studying the operation, select untouched year- 
lings or two-year-olds for his first patients, the 
yearlings being preferable to the two-year-olds. 

Complicating conditions in young patients are 
exceedingly rare; in older ones they are much 
more common. Adhesions, hyperplastic and 
cystic testicles and the partially descended and 
strangulated testicles are all results of age. Older 
animals are more difficult to confine properly and 
being more liable to present complicating con- 
ditions are more apt to suffer from the accidents 
of the operation. 



74 SPRINGTIME SURGERY 

To the beginner I would recommend that he 
select a young patient, and before operating care- 
fully map out his plan of procedure. Nothing 
counts like system and nothing succeeds like the 
uniformly systematic man. 



Cryptorchidectomy in Horses* 

By C. E. Steel, D. V. S., Oklahoma City, Oklahoma 

Comparatively few of us have the opportunity 
to castrate cryptorchids often enough to become 
really proficient in this operation and yet it is one 
that, with a knowledge of the anatomy of the 
part concerned in the operation and with modern 
surgical antiseptic and aseptic measures at our 
command, the average practitioner should not 
"side-step" in favor of the so-called specialist, 
who often is anything but clean and scientific 
in such work. 

As Dr. L. A. Merillat has said: "It is indeed 
remarkable how one can mutilate a ridgling with 
impunity in the frantic search for a well hidden 
testicle, if the parts are not infected in the effort." 
Most of us know of one or more empirics who 
are successful ridgling operators in spite of their 
uncleanly methods and utter ignorance of asepsis 



♦Reprinted from Missouri Valley Veterinary Bulletin, January, 1910. 



76 SPRINGTIME SURGERY 

and antisepsis. When we compare our own 
efforts with such men, we are somewhat inclined 
to lose faith in the value of antiseptic precau- 
tions and to lose confidence in ourselves. 

From long practice, professional ridgling cas- 
trators become expert and the' time required to 
perform the operation with them, usually amounts 
to but a few seconds or minutes after the animal 
is secured. With the hands of the skillful 
though unscientific operator ordinarily clean, 
the peritoneum is far less likely to become con- 
taminated than with the inexperienced operator, 
who usually employs some half-way measures 
toward securing asepsis and frequently hunts for 
the testicle for dn hour, or more, and sometimes 
even then fails to find it, much to his own em- 
barrassment and humiliation. The obvious de- 
duction is supplant lack of experience by the 
strictest precautionary measures at our hands. 
In fact, however skilled one becomes he should 
most religiously follow the technic of preparing 
the operative field, instruments and hands, as 
though he expected to search indefinitely for the 
hidden testicle. 



CRYPTORCHIDECTOMY IN HORSES 77 

The following is about the routine which I 
have employed and, I may say considering the 
number it has been my lot to operate upon dur- 
ing the past few years, and the results attained, 
it seems to be a practical method. 

I first apply a twitch to the nose, lightly, and 
make an inguinal examination with the animal 
in the standing position. In some horses in good 
condition, particularly those over two years old, 
the superficial inguinal lymphatic glands may 
deceive one, especially in nervous or ticklish ani- 
mals, in which squeezing these glands may cause 
them to flinch, much as would pressure upon the 
testicle itself. The importance of this prelimi- 
nary step is considerable in some cases, as many 
owners of ridglmgs are not willing to assume the 
risk incidental to the operation, and the veteri- 
narian's sense of touch is called upon to decide 
whether the horse is an abdominal ridgling or 
merely a "high flanker. mi In exceptional cases it 
may be necessary to caste the animal to make a 
correct diagnosis, but in horses thin in flesh it is 
an easy matter to determine whether they are 
ridglings. 



78 SPRINGTIME SURGERY 

The animal is prepared for the operation by 
withholding feed and perhaps water for a period 
of twenty-four hours, depending somewhat on 
his condition ; this is not always advisable, as cir- 
cumstances may make it inconvenient or im- 
possible. For casting select a grassy spot away 
from manure heaps and other insanitary con- 
ditions usually met with around stables, and tie 
up the tail securely. With a modified Conkey 
throwing harness and a hood to protect the eyes 
of the patient cast and tie him. I do this myself 
with the aid of one man at the head and another 
with one of the side-ropes. But it is preferable 
to have an experienced assistant to do the hand- 
ling of harness and ropes, and tie up feet with 
damp cloths. Having previously scrubbed my 
hands with a brush and thoroughly cleansed 
nails with water and soap and rinsed well in a 
1-3,000 bichloride solution, have an emasculator, 
ecraseur, curved needles, sterilized silk, artery- 
forceps, and convex bistoury, or regulation cas- 
tration knife at hand in one per cent chinosol 
solution in a clean pan. I have also a kettle of 
boiled water, cooled to luke-warm temperature, a 



CRYPTORCHIDECTOMY IN HORSES 79 

clean pan, a cake of soap and clean towels ready 
for use and after having an assistant wet down 
the entire abdomen to allay flying hairs and dust, 
i have the scrotum and inguinal region scrubbed 
well with soap and water, containing any relia- 
ble antiseptic, then thoroughly rinsed with bichlo- 
ride solution, 1-3,000 strength. If I have had to 
assist in the castrating (with gloved hands, of 
course) I proceed to wash my hands and wrists 
in same strength solution, and with twitch ap- 
plied to the patient's" nose, make a four or five- 
inch incision about one inch from the median 
line. I prefer the side on which I am operating, 
uppermost. In making the incision I try not to 
go deeply, and thus avoid wounding the large 
scrotal veins that may lie in such a tortuous net- 
work that it is hard to keep from cutting them 
if the knife goes deep. If, however, any of the 
larger blood vessels are severed, it is not a diffi- 
cult matter to take up with artery-forceps and 
ligate, a thing it is advisable to do at once. 

If the animal has not been operated upon 
before, it is an easy matter to break or tear down 
the fascia in an outward and forward direction 



80 SPRINGTIME SURGERY 

for a distance of from six to ten inches, depend- 
ing upon size and condition of animal. If, how- 
ever, he has been tampered with, the cicatrical 
tissue may offer considerable resistance. One 
should use judgment though, and be sure to 
break down sufficient tissue to insure plenty of 
working room for the hand, so as not to tire it in 
succeeding steps of the operation. 

Having penetrated to the above-named dis- 
tance, one should be in the neighborhood of the 
internal inguinal ring, which is recognized by a 
much thinner feeling than the surrounding parts. 
A rotary motion of the hand will aid in reaching 
the part, and some operators employ sterilized or 
antiseptized oil to facilitate the process. I have 
never used oil. When my fingers have reached 
the peritoneum covering the internal inguinal 
ring I instruct the man at the head to tighten 
the twitch, and at the instant of full inspiration I 
perforate it with either index or second finger 
or both, and usually contact the testicle immedi- 
ately. In many cases, however, I have had to 
search or finger for the organ or the vas deferens 
for varying lengths of time, but in no case have 



CRYPTORCHIDECTOMY IN HORSES 81 

I found it necessary to insert more than two 
fingers into the abdominal cavity excepting where 
a cystic formation or other abnormality was 
present. 

The fecal matter in the floating colon is not 
to be mistaken for the testicle, being easily dis- 
tinguished by its softer consistency. Mesenteric 
arteries should be easily recognized by their dis- 
tinct pulsations and not mistaken for the vas 
deferens. A flabby, undeveloped testicle and epi- 
didymis, however, closely resemble in touch the 
small intestine. In a number of cases I have 
withdrawn the small bowel to the outside suffi- 
ciently to recognize it, without bad after-effects. 
An assistant with the ability to recognize a tes- 
ticle through the rectal wall, can sometimes 
render valuable aid in locating the missing organ 
and the operator should resort to it himself with 
his disengaged hand and arm, rather than keep 
the animal down unnecessarily long ; prompt and 
careful cleansing of the hand and arm by an as- 
sistant before the instrument or the operating 
field is touched during the remainder of the 



82 SPRINGTIME SURGERY 

operation will usually avoid infection from the 
procedure. 

When the testicle has been located and brought 
into view it is removed either with an emascu- 
lator or an ecraseur and the opening into the abdom- 
inal cavity carefully examined to determine the 
size of the peritoneal opening and make abso- 
lutely sure that no bowel protrudes. If, by any 
mischance, a larger opening has been made than 
one feels safe in leaving, even when no intestines 
have escaped, I prefer to pack carefully the en- 
tire wound and stitch the packing in with a con- 
tinuous suture. In ordinary cases, such packing 
is not necessary. 

In releasing the animal, I prefer to have him 
stand quietly for from six to twelve hours. If 
he has been packed, instruct the owner how to 
remove the gauze, and have him turned to grass, 
or exercised sufficiently to overcome soreness. 
Should swelling occur around the scrotal wound, 
insist strenuously on exercise, first, last and 
every time. If peritonitis develops after such an 
operation as described, the animal is doomed to 
die, in nearly all cases, in spite of treatment. 



An Interesting Monorchid* 

By Frederick Hobday, F. R. C. V. S., London, England 

This, a two-year old chestnut cart-horse, be- 
longing for Mr. T. Stainton, M.R.C.V.S., was of es- 
pecial interest as it proved to be a true mon- 
orchid. There was no evidence or history of any 
prior attempt at castration ; in fact, it was known 
with certainty that no testicle had ever been re- 
moved. The left one was present in the scrotum 
and was removed without any trouble. On the 
right side the abdomen was penetrated in the 
usual situation, close to the inguinal ring, and a 
careful search revealed not only the absence of 
testicle, but a gradual merging of the end of a 
rudimentary cord into the lining of the perito- 
neum of the pelvis. After making sure of this 
by tracing it repeatedly, the hand was withdrawn 
and the inguinal canal carefully closed by sutures. 



♦Reprinted from the American Journal of Veterinary Medicine, 
October, 1910. 



84 SPRINGTIME SURGERY 

The colt was allowed to come out of his anesthe- 
sia and he got up apparently none the worse for 
his experience. This was about 5 o'clock. At 
10:15 p. m. the animal was heard to be making a 
noise in the box as if in violent pain, and upon 
examination the bowels were found to have de- 
scended. The weight had ruptured one of the 
sutures and a loop of bowel had come down nearly 
as far as the hocks. 

Assistance was summoned, and after consider- 
able difficulty the colt was cast and the bowel re- 
turned. As much washing and disinfecting was 
done as was possible under the circumstances, and 
a plug of cotton wool was inserted. This was in- 
serted underneath a row of sutures, and then fol- 
lowed by a second row of sutures, in such a way 
that the pad could be changed without danger of 
allowing the bowel to escape, the first layer of 
sutures not being touched or interfered with in 
any way. 

On the following morning the colt's tempera- 
ture was 103° F., and during the subsequent days 
it varied between 102° and 103° F. The pad of 
cotton wool was changed on numerous occasions, 



AN INTERESTING MONORCHID 85 

and febrifuges, tonics, or stimulants were admin- 
istered internally at discretion. Antistrepto- 
coccic serum was also given. 

Peritonitis was evidently present, and in spite 
of all efforts death eventually took place a month 
after the operation. 

An autopsy at which Dr. Kendall, D. V. S., 
M. R. C. V. S., and Mr. Benson, M. R. C. V. S., in 
addition to Mr. Stainton and myself were also 
present, confirmed the absence of any testicle on 
the right side, nor was there any evidence of such 
an organ ever having existed, the spermatic cord 
being clearly traceable and merging impercepti- 
bly into the peritoneum of the pelvis. Such cases 
are rare, and are worth recording. I have already 
reported a similar case in my little brochure upon 
"Cryptorchid Castration," and a further still more 
curious point in which both testicles were absent. 

The remainder of the autopsy was of interest 
only in connection with the peritonitis. The loop 
of bowel which had descended was matted to- 
gether, and there was a long abscess between the 
two portions of the loop. This contained a piece 
of dirty straw which must have been overlooked, 



86 SPRINGTIME SURGERY 

as it quite readily might have been, when the 
bowels were washed and returned. 

On the left side the end of the cord from which 
the testicle had been removed could be found 
quite easily, and had nothing about it upon which 
to make any comment. 



A Castrator's Error* 

J. L. Perry, M. R. C. V. S., Cardiff, Wales 

I received a letter asking me to attend a cart 
horse, aged three, upon which an attempt at cas- 
tration had been made by an unqualified man 
three days previously. 

The owner said in his letter: "The castrator, 
a man who does all that kind of work about here 
and has hitherto been most successful, 'bunched' 
up something in the clam. I saw at once it was 
not a testicle, and told him so. He insisted that 
the colt was malformed and that it was the other 
testicle all right. I, however, left in disgust, and 
learned afterwards that he had at once proceeded 
to sear through this 'something' with the hot iron, 
immediately this was completed about twelve 
inches of penis fell from the horse's sheath to the 
ground," So he had amputated the penis in mis- 
take for a testicle! He then found and removed 



♦Reprinted from American Journal of Veterinary Medicine, May, 1911. 



88 SPRINGTIME SURGERY 

the other testicle. The horse was now very weak 
and ate but little, his sheath was a tremendous 
size, like a sack of potatoes. 

Mr. C. E. Smith, M. R. C. V. S., saw the horse 
in my stead. He found the sheath almost justi- 
fied the description given it by the owner of the 
horse. It was engorged and pointing in places 
with infiltrated urine. After casting the animal 
and well lubricating the inside of the sheath with 
vaseline, he discovered, after a lot of tedious manip- 
ulation, the mutilated end of the penis about a 
foot away from the natural opening of the sheath. 
The swelling being so severe, the urine could only 
come away in a small dribble, so he decided to 
make an opening for the penis stump to come 
through the sheath in a position close to the 
proper castration wounds. The urethra pro- 
truded about one-eighth inch, but it was impossi- 
ble to get a skin attachment for it; so it was left 
as it was with the intention of completing this 
part of the operation later on when the swelling 
had subsided. Punctures were made in various 
parts of the sheath to allow the urine which had 
infiltrated into the surrounding tissues to drain 



A CASTRATOR'S ERROR 89 

away. All the parts were thoroughly cleansed 
with warm antiseptics and dressed with carbo- 
lized vaseline. 

I saw the case myself ten days afterwards. 
The sheath was slightly swollen; horse eating 
and improving in condition. Standing behind 
him and pulling the tail aside I could see about 
four inches of penis hanging through a wound 
in the sheath, and in position just where a mare's 
teats would be. The penis pointed downwards 
and backwards, and when urination took place 
there was a stream about the calibre of a clinical 
thermometer case directed upon the points of the 
hocks. The urethral opening was clearly dimin- 
ished in lumen, and I told the owner that the 
horse should be cast again, and a further small 
portion of the penis removed so that the urethra 
could be properly everted and stitched back to 
avoid further stricture. This he would not con- 
sent to, preferring to "wait and see" how the 
horse went on. 

I was not asked to attend the horse again, but 
being in the locality a month or two afterwards 
saw him at grass. Both hocks were then in a 



90 SPRINGTIME SURGERY 

terrible mess, due to the constant dribbling of 
urine upon them. The urethral opening was evi- 
dently very small, as one could see the urine com- 
ing away from the penis in a very fine spray. 
Owner still refused surgical interference. I 
wrote him about twelve months ago on another 
matter, and asked him how "Farmer" was going 
on, expecting to hear he had been sent to the 
kennels. His reply was, "The horse is working 
on the farm regularly, and except for requiring 
an occasional drench does all right." 

I might add that I tried at the time to per- 
suade the owner to institute proceedings against 
the castrator, either for cruelty or in a civil court, 
but this he would not do, the reason being, as I 
learned afterwards, that he had arranged terms 
for the castrator to pay him the sum of $125 in 
instalments, as damages. This would, of course, 
account for his desire to avoid further expense 
or publicity. He wanted the matter kept quiet 
till the money was paid; hence also his employ- 
ing me in lieu of other veterinarians nearer his 
home. 



Hemorrhage After 
Castration* 

By Wirt R. Barnard, D. V. S., Belleville, Kansas 

I was called to see a two-year-old colt castrated 
nine hours previously by a non-graduate prac- 
titioner. The owner had stopped the hemorrhage, 
but I found the colt very weak and staggering, 
pulse imperceptible, respiration abdominal and 
hurried. I administered one dram of nux vomica 
and in thirty minutes noticed great improvement. 

The next morning, the owner telephoned the 
colt was down, unable to rise, and acting crazy. 
I made the call and gave nine pints of normal 
saline solution intraperitoneally. The colt ate 
and drank well, but after attempting to rise 
showed cerebral disturbance. I left a mixture of 
nux vomica, belladonna, digitalin and ferric 
chloride to be given in full doses every two hours. 



♦Reprinted from the Missouri Valley Veterinary Bulletin, May, 190& 



92 SPRINGTIME SURGERY 

In addition to this the colt was fed one-half 
gallon of fresh milk, one-half dozen eggs and one- 
fourth pound of sugar, well-mixed, twice daily, 
and all the hay and grain he wanted. After three 
and one-half days he got up on his own accord 
and has been doing well ever since. I noticed 
a decided change for the better after giving the 
saline injection and had not the distance from 
my office been so great I would have given a 
second injection. 

At another time I was called to see a two-year- 
old mule that was bleeding badly, a result of 
castration by an empiric. I checked the hemor- 
rhage externally, but the colt died twelve hours 
later from internal hemorrhage. I was called to 
this case in the night and the weather was so dis- 
agreeable and the lack of conveniences such, that 
I did not throw this colt and secure and ligate the 
artery — the only proper procedure. The animal 
died in spite of all medication though I now be- 
lieve that full physiological doses of atropine hy- 
podermically would have checked this as it will 
most other internal hemorrhage. 



Castration of Pigs Having 
Scrotal Hernia 

By D. M. Campbell, D. V. S., Chicago 

Cases of scrotal hernia in pigs or a rupture 
as the farmer calls it is a markedly hereditary 
condition. On some farms from year to year 
there are numerous cases of this kind among the 
pigs; on other farms this condition is scarcely 
known, its presence or absence depending, as may 
easily be demonstrated, upon heredity. 

Some farmers castrate these pigs as readily as 
they castrate their ordinary boar pigs, but a great 
many others find the operation difficult or are en- 
tirely unable to perform it and with them such 
pigs are usually destroyed as soon as the hernia 
is noted or the condition is allowed to grow worse 
until death results from strangulation of the in- 
testine or from a traumatism to the scrotum. 



94 SPRINGTIME SURGERY 

The value of the animal is so slight that 
unless there is a considerable number of these 
"ruptured" pigs in the same brood or there be a 
very large number of hogs raised upon the place, 
this work can never amount to much from the 
veterinarian's point of view, but frequently when 
he is called to a farm for other work he is asked 
to castrate one or two or three of these pigs. 

There is scarcely an operation that is more 
simple than this one and yet it is one with which 
some veterinarians have experienced a great 
deal of difficulty, because of faulty technic. To 
throw the animal, hold him on his side and at- 
tempt to castrate him, as is done in ordinary cas- 
tration is to bring on such forcible extrusion of 
the intestines that no operator can successfully 
accomplish the castration, but if the pig be held 
up by his hind legs with his back to the holder 
and with his forefeet just touching the ground 
and possibly his neck between the ankles of the 
man holding him the intestines will of their own 
accord, or can readily be made to, return to the 
abdominal cavity and while held in this position 
castration is an exceedingly simple operation. 



SCROTAL HERNIA 95 

Observe the usual aseptic precautions advisable in 
all minor surgery. If the inguinal aperture in 
the abdominal wall is very large it may be neces- 
sary to hold the testicle through the scrotum while 
the intestines are manipulated to prevent its re- 
turn into the abdominal cavity along with the 
intestines, in which case the animal would have to 
be lowered before the testicle would again return 
to the scrotum, thus causing annoyance and repe- 
tition of the manipulation of the intestines. 

Holding the testicle between the thumb and 
fingers as for ordinary castration cut through the 
skin and dartos as for the covered operation. 
Strip the cellular tissue from the tunica vaginalis 
as close up to the internal inguinal ring as it is 
possible to get. Then place a ligature very tightly 
around the tunica vaginalis or sac including the 
cord, vas deferens, the arteries, veins and nerves, 
first making certain no portion of the intestine is 
included in the ligature and that it is close enough 
to the internal inguinal ring to prevent subse- 
quent saculation and a further escape of the in- 
testine from the abdominal cavity. The ligation 
may be made with any stout cord, that has been 



96 SPRINGTIME SURGERY 

rendered aseptic and the ends of it should be left 
long enough to hang slightly out of the scrotal 
wound. Cut off the cord with its covering mem- 
brane just back of the ligation. It is a serious 
mistake to incise the tunica vaginalis before the 
cord is ligated. Remove the other testicle and 
the operation is complete. 

The peritoneal surfaces of the tunica vagi- 
nalis will adhere in a few hours and in two or 
three days the portion of the tunic below the 
ligation will slough off and come away together 
with the string with which it is tied. It is neces- 
sary to make the wound rather low so that drain- 
age may be free. The entire operation requires 
less than one-half the time it takes to describe it 
and the mortality is practically nil. 

It may be beneath the dignity of some veteri- 
narians to charge a fee for this operation but the 
operation is not too insignificant to be appre- 
ciated by the owner and it is well worth while 
viewed from any angle. If undertaken at all 
of course it should be well done. 



Operation on 
a Hermaphrodite 

By 0. D. Chedester, D. V. S., Cordell, Oklahoma 

Hermaphrodism is a condition in which there 
is a combination in a single individual of both 
male and female generative organs. In some 
cases, the individual possesses only one set of in- 
ternal genitals, but both male and female exter- 
nal genitals. In others the internal genitals of 
both sexes are present. The former class is the 
more common and to it the case described below 
probably belonged. Hermaphrodites which simu- 
late the male more nearly than the female are of 
much more frequent occurrence than are those 
which most nearly resemble the female. 

A client of mine possessed a small, four-year- 
old, bay, hermaphrodite horse, weighing less than 
900 pounds. The head, neck and shoulders of 



♦Reprinted from the American Journal of Veterinary Medicine, 
March. 1912. 



98 SPRINGTIME SURGERY 

this animal resembled a stallion. The posterior 
half of the body with its perfect udder, resembled 
a mare. Its disposition was that of a stallion. 
The short penis, about three inches long, in an 
almost continuous state of erection, extended 
through a small opening six inches below the 
anus. Through this penis the urine wag passed, 
usually dropping on the tail, legs and buggy 
wheels though it sometimes reached the dash- 
board, making it disgusting as well as embarrass- 
ing to drive the animal. 

The faults of this critter were many. It could 
not be safely turned out with other horses or 
even into a pasture adjoining one in which other 
horses were kept. It could not be worked with 
other horses with any satisfaction. Every equine 
looked to it like a mare in estrum. With half an 
opportunity it would mount as for copulation 
and with the aid of its tail pressed against the 
erected penis would discharge the semen in its 
own tail. This young animal, though quite a 
curiosity, was worthless for practical purposes. 
The case, however, offered a fine opportunity for 






A HERMAPHRODITE OPERATION 99 

some experimental operating on my part, and as 
the owner agreed to it, the experiment was made. 

This animal was cast and chloroformed; the 
tail bandaged and the operative field cleansed. 
A sterile soft catheter was introduced and the 
bladder and the urethra irrigated with an anti- 
septic solution. The penis was dissected one 
and one-half inches inward and upward and ampu- 
tated, leaving the urethra protruding one-fourth 
of an inch. The catheter was left in situ and the 
bladder and urethra irrigated daily with a five 
per cent potassium permanganate solution for one 
week. The wound was given a daily dry dressing. 

Owing to the position and irregular size of the 
urethra the amputation was much more difficult 
than this operation is ordinarily. Two weeks 
later a second operation was performed by lay- 
ing open the urethra for a distance of three 
inches, thus for urinary purposes replacing a 
vulva. The wound was packed and the edges al- 
lowed to heal without uniting. From this open- 
ing the urine is now expelled as expeditiously 
as it is from the urethra of a mare. 



100 SPRINGTIME SURGERY 

The patient #vas given the following treatment: 
Nucleinic acid (yeast) grs. xii 

Sodium chloride grs. vi 

Sodium bicarbonate grs. v 

Phenol m. ii 

Aqua destillata oz. i 

Mix, filter and give hypodermically one dram 
twice daily in an equal quantity of normal saline 
solution. In one week the animal was well and 
ready for work and medication was discontinued. 
As the testicles, if developed, were in the ab- 
dominal cavity, their removal was planned for a 
third operation, but never attempted because not 
necessitated by the changed disposition of the ani- 
mal which strangely enough from the first opera- 
tion became docile and began to grow and fatten 
until now it weighs more than 1,300 pounds. It 
can be turned loose or worked with other horses 
with satisfaction, and is a beast of burden equal 
to a mule. How are we to explain the loss of 
sexual desire without the removal of either testi- 
cles or ovaries? 



Spaying Heifers on Western 
Ranches' 

By A. W. Whitehouse, D. V. S., Boulder, Colorado 

Calls for this work on the part of the cow- 
men are not at all regular, and depend on three 
factors: the demand for breeding she-stock, the 
price at market points on fat open-cows and 
heifers, and the amount of available grazing. 
Perhaps the most important of these is the price 
of fat open-cows. When, as at present, these sell 
within a dollar or a dollar and a quarter of steers 
of similar breeding, very little spaying will be 
done. There is now no discrimination at mar- 
ket points against spayed heifers as such, and 
they sell on their merits at a price fully equal to 
steers in similar condition. This is as it should 
be, for they certainly dress out as well as steers, 
and sometimes better. 



♦Reprinted from the American Journal of Veterinary Medicine, 
April, 1911. 



102 SPRINGTIME SURGERY 

One big outfit for which I have worked, from 
an annual brand of about 2,000 calves of both 
sexes, "cuts" the poorer half of the heifers for 
spaying each year, and this bunch, though it con- 
tains all the odd colors and ill-shapen calves, is 
said to make them more money than the open 
heifers or the steers. Spayed heifers are quieter 
than steers, and though they will not quite come 
to the same weight, they will ripen more quickly, 
and on very much less feed. 

In discussing spaying with an owner who is 
contemplating it for the first time, it is well to 
advise him to be prepared to carry the heifers 
over at least two seasons, as it requires that 
length of time for the complete unsexing of the 
carcass and to derive the full benefit of the 
operation. 

While the median-line operation is easier and 
quicker, and the immediate loss, providing the 
stitching is quite perfect, should be no greater, 
yet there are good reasons for preferring the 
flank operation. One of my clients has had a 
good opportunity to compare their merits, and I 



SPAYING HEIFERS 103 

have been able to confirm his observations. Hav- 
ing 400 flank-spayed yearlings of his own breed- 
ing, he purchased 800 median-line spayed year- 
lings from a neighbor, the operations having been 
performed within six weeks of each other. 
Among the flank spayed yearlings were a very 
few rather persistent stitch abscesses (in a 
harmless place) which eventually disappeared. 
Among those operated upon through the median 
line there were a number of hernial sacs, and 
more having a (supposedly peritoneal) fistula 
which discharged a fluid usually clear. These 
did not fatten, and some few died, a year to 
eighteen months later. 
This is my technic for the flank operation: 
Preparation. — Just preceding the spaying, 
thirty-six hours of starvation is desirable but not 
often obtainable on the range from lack of suit- 
able corrals. The animals should be watered the 
night before the operation or they get too 
"proddy." 

Restraint.— I have never tried the chute and 
should suppose it slow. It is desirable to jam a 
lot of them in a small corral for roping and 



104 SPRINGTIME SURGERY 

"snake" them out into a big corral of at least 
an acre for the operation. If the operating 
corral is small the spayed heifers are always 
charging the operator. We usually rope them 
by the head and the hind feet and stretch them. 
The upper or left-forefoot goes into the neck 
noose and a figure of eight is put on just above 
the hind fetlocks. The adjustment of this re- 
quires a good man on the tail. It is best to 
have a man sit on the head with the forefoot 
pulled over with a handle noose. It is hard, 
however, to get the boys to do this as they 
prefer to stretch them between two horses. This 
brings the abdomen too tight, and after breaking 
through it is often necessary to ask the man on 
the hind rope to slacken, so that occasionally the 
heifers kick loose from the figure eight knot. 

Field of Operation. — Have the left side 
uppermost in the recumbent position; stand at 
the loin and rump and not at the abdomen. Grasp 
all of the flank you can get into the left hand and 
tense the skin. About two inches from the heel 
of the hand begin the incision and cut straight 
towards you — make it plenty long enough for 
easy work. 



SPAYING HEIFERS 105 

I never clip or shave the hair from the field of 
operation, considering that there isn't time to do 
a good job and I am more likely to introduce 
clipped hair than loose hair, though I often find a 
little of the latter in my hand. I swab the field 
very freely with a two per cent solution of zeno- 
leum or some of the coal-tar disinfectants. 

The incision will be very little if any forward 
of the point of the ilium and will be surprisingly 
low down when they get up. Here the external 
oblique muscle is aponeurotic. I make an in- 
cision parallel with the fibres about one inch long 
and enlarge with the index finger of each hand. 
I then force my right hand cone-shaped into the 
incision and as soon as I feel the peritoneum, 
jerk in my hand so as not to separate it from 
the wall. 

Equipment. — I wear blue overalls and a 
jumper, a clean suit each morning; have my shirt 
sleeves rolled up but the jumper sleeves hanging 
loose for a protection from the sun. 

For the skin and aponeurotic incision I buy 
old razors and carry four with me. The blade is 
ground away so that there is only about one inch 



106 SPRINGTIME SURGERY 

of it left at the end and a cutting edge put on the 
heel. I have a scalpel in my pocket but seldom 
use it. The other instrument is a pair of curved 
serrated shears six and one-fourth inches long 
such as some use for spaying bitches. I have a 
pair of long spaying shears (serrated) and a 
spaying emasculator but never use them. 

At the fence I have several pans, etc., and the 
instruments go into a five-percent carbolic acid 
solution when not in use. One pocket of my jump- 
ers I keep soaked in five percent carbolic acid and 
carry the instruments in it. I wash as often as 
possible in surgeon's boric-acid soap and water, 
but I cannot stand antiseptics in it for more than 
half a day's work. 

Removal of Ovaries. — After breaking in, as 
described, I turn the fingers toward the pelvis 
keeping the peritoneal wall in touch and with the 
back of the hand push back a fold of intentine. 
The left ovary should lie close at hand. I grasp it 
and bring it to the surface and with an instru- 
ment, razor, scalpel, or scissors shred the broad 
ligament till the ovary lies passive, but attached, 
in the left hand. Possibly dipping the right arm 



SPAYING HEIFERS 107 

in the swab bucket I reintroduce it and follow the 
broad ligament to get the right ovary. Sometimes 
the tension has brought this within two inches of 
the surface and sometimes it is very hard to find 
(the weak point of the recumbent operation). I 
break down the broad ligament by passing the 
fingers through it and gradually bring it to the 
surface. This breaking through the broad liga- 
ment is very wearing on the skin of the fingers, 
soaked as it is, and the ligament cuts nearly to the 
bone on the first and fourth fingers near the distal 
joint. If the ligament is tough it needs shredding 
with the scalpel held in the left hand ; it is rather 
risky to transfer the ovary to the left as it snaps 
back if the heifer struggles. Most of them, how- 
ever, come out on a shred. I never introduce an 
instrument into the cavity, feeling that in rough, 
hasty, routine work there is danger in so doing. 
Finally I shred the ovaries off, using an instru- 
ment if necessary. 

Sutures. — One in the aponeurosis of the ex- 
ternal oblique and two in the skin — all three in- 
terrupted. I use common string cut in suitable 
lengths, soaking it all day in a strong coal tar 



108 SPRINGTIME SURGERY 

dip, ten percent solution. An assistant does this 
work. He dips his hands frequently in an anti- 
septic solution. Most of the heifers go to market, 
but one of my clients has butchered a few and he 
tells me that there is an adhesion of skin and 
deeper structures at the operative wound, but 
that the string has disappeared. When every- 
thing is going smoothly the operator works a 
little faster than the stitcher. 

Steel sacking needles, five inches long are best 
but the six-inch needle will do. Have a mechanic 
take the temper out, and give them a slight curve 
in the pointed one-third, with the curved part 
flattened and a cutting edge on each side and then 
re-tempered. Good steel needles are hard to get, 
the common ones will not do. The edge should be 
kept sharp enough to cut the suture string when 
the stitches are complete. This is the only good 
design for a needle. Such a one will go through 
the gastrocnemius tendon or plantar cushion with- 
out hard pressure and without a jerk. 

After Treatment.— I dress liberally with pine 
tar thickened with flour according to the weather 
and let them drift on to good pasture direct from 



SPAYING HEIFERS 109 

the corral; if they have to be moved it must be 
by good cowmen and very carefully. Confinement 
in a lot, or corral, I have never tried and should 
not care to. 

Failures. — In about one percent I fail to get 
the deep ovary in a reasonable time and let 
them up. 

I never spay pregnant heifers, stopping at 
once even if I have removed the left ovary before 
being aware of the condition. 

Mortality. — When the last bunch I spayed 
was nearly finished the boys broke the leg of one 
in throwing her, but I think they were getting 
tired of bacon. In each of two lots that I spayed, 
one heifer was found dead about six weeks later, 
tion. This has been the total loss among up- 
wards of 1100 heifers spayed during 1910 and 
1911. I am not a quick operator, about 125 
heifers a day being my limit, and the antiseptics, 
peritoneal fluid and sun are very hard on my skin. 
If my results have been good I attribute it to two 
things: first, reasonable cleanliness, and second, 
never using an instrument except on structures in 
plain view. 



110 SPRINGTIME SURGERY 

Prospective. —Spaying heifers is becoming more 
and more popular on the ranges as the price of 
good beef increases over that of poorer grades. 
And resident veterinarians are doing a larger and 
larger percentage of this work which was for- 
merly done almost exclusively by itinerant "special- 
ists/' No veterinarian locating in this region 
can afford to neglect spaying. 



Oophorectomy in Cats* 

By Q. E. Corwin, Jr., D. V. S., Canaan, Conn. 

In performing feline oophorectomy and to in- 
sure a successful termination, the operation 
should differ materially from that usually per- 
formed upon bitches. 

If the median-line operation is followed with 
cats, they will invariably remove, or at least dis- 
turb, the stitches and always give more or less 
trouble if not actually bringing on a fatal termi- 
nation by this means. Upon cats the following 
technic for the operation will give best results : 

Place the animal upon a slanted table, sus- 
pended by the hind legs and with the head low- 
ered. Shave and disinfect the skin for the flank 
operation, either side, and when properly pre- 
pared anesthetize with ether. 

In making the incision, first make it through 
the skin only, at a point anterior or posterior to 



♦Reprinted from the American Journal of Veterinary Medicine, 
December, 1911. 



112 SPRINGTIME SURGERY 

the incision to be made in the muscle and perito- 
neum, then draw the skin incision to the point to 
be incised in the muscle. 

Pick up, with the sterile, little finger, the fallo- 
pian tubes, which can readily be located without 
the use of the probe. 

Draw the ovaries into the incision and remove. 
Return the tubes. Suture the muscles and peri- 
toneum with the same interrupted, sterilized, 
catgut sutures, (two probably being enough) 
wipe dry with sterile absorbent cotton, and allow 
the skin incision to return to its proper position, 
which will cause the incision in the muscle to be 
entirely covered. 

Do not put any suture in the skin incision, and 
the cat will do no other harm to it than licking. 
If sutures are used in the skin the cat will try to 
and usually does remove them. This is the pri- 
mary cause of the median-line incision being so 
troublesome. 

Do not use any carbolic preparation for disin- 
fecting instruments to be used on a cat, nor use 
any such preparation for disinfecting the skin of 
these animals. I prefer chinosol. 



Prolapsus Uteri : Its Successful 
Treatment* 

By A. J. Treman, D. V. M., Lake City, la. 

On the morning of May 17, 1909, the phone 
wakened me uncomfortably early. Answering it, 
I learned that a farmer eight miles away wanted 
me to come, in a hurry, to his place. His answers 
to a few questions revealed that he had a mare 
with an eversion of the uterus. I directed him to 
get a large dishpan, fill it with clean hot water 
and place the everted mass into it and keep pour- 
ing hot water over it continually until I arrived. 

When I arrived, I found a fine large five-year- 
old, mare, with a complete eversion of the uterus 
and vagina. The pulse was weak and rapid, res- 
pirations hurried and distressed, the animal 
suffering considerable pain and quite weak; how- 
ever the owner had carefully followed my instruc- 
tions, and all hemorrhage was stopped, there was 



♦Reprinted from American Journal Veterinary Medicine, Dec, 1911. 



114 SPRINGTIME SURGERY 

only moderate swelling of the mass, all the parts 
were reasonably clean and pliable and ready to 
be replaced. I immediately administered hypo- 
dermic stimulants and a small dose of aromatic 
spirits of ammonia, then proceeded to put myself 
in readiness to replace the organ. By the time 
this was done, I found that the patient was show- 
ing some effect from the stimulant. 

With some difficulty we succeeded in getting the 
animal upon her feet, after which it was com- 
paratively easy to replace the organ. With the 
return of the uterus, I inserted my hand and arm, 
as the Dutchman said, "Yust so far as I had any," 
and did what I could to restore all the parts to 
their natural position, meanwhile resisting the 
animal's straining. While my hand was still in 
the uterus, I had an assistant pump in a pail full 
of clean, hot, weak, disinfectant solution, this dis- 
tended the uterus and horns to such an extent 
that I was able to restore all the parts to their 
normal position before the animal strained 
enough to throw out any of the solution. Then 
I siphoned off the liquid, injected more and si- 
phoned it off, and kept on repeating this until 



PROLAPSUS UTERI 115 

the liquid was returned clean and there was a 
contraction of the uterus to such an extent that 
on withdrawing the hand I was able to siphon off 
practically all of the liquid. After this there was 
very little straining, and though I placed a truss 
in position it was not really necessary. 

For several hours we had to be very faithful 
with our stimulants, and left generous doses of 
quinine, iron and strychnine to be given. On the 
second and third days following, we thoroughly 
flushed the uterus. This animal made a com- 
plete and uneventful recovery. I have had other 
cases that seemed hopeless make a nice recovery 
under this plan of treatment, two points of which 
I wish to emphasize. 

First. Endeavoring to get the owner to thor- 
oughly irrigate the prolapsed mass until I get to it. 

Second. Filling the returned uterus with a hot, 
weak, disinfectant solution, to help in restoring 
all parts to their normal positions, and the re- 
peated injections and siphoning of the solution 
until there is a strong contraction of the organ. 
This I find valuable in all cases where flushing is 
necessary. 



Unusual Case of Obstetrics* 

By Dr. H. Jensen, Kansas City, Missouri 

A gentleman called at my office stating that 
one of his valuable brood mares was having labor 
pains though she was not due to foal for a couple 
of months. A few doses of viburnum was pre- 
scribed and I heard nothing more about the 
matter. 

About two months later I was called to his 
place and informed that in the forenoon this 
mare had given birth to a dead colt but kept on 
straining. On examination I found lodged in the 
os a scapula, and in the uterus I found the com- 
plete skeleton of another foal. All the soft struc- 
tures were gone, the bones all disarticulated but 
no decomposition. The uterus had contracted 
considerably by this time, and a number of bones 
were firmly imbedded in the folds of the uterus, 
the womb was flushed a few times with antisep- 
tic astringents and recovery of the mare followed. 



♦Reprinted from the Missouri Valtey Veterinary Bulletin, August, 1909. 



Proper Replacement of 
the Everted Uterus* 

By Sam Meader, D. V. S., Goff, Kansas 

Eversion of the uterus is a very common occur- 
rence in cows. Presumably the reason for the 
greater frequence of this condition in cows than 
in other animals is on account of the closer union 
in this animal between the placenta and the uterus. 
The peculiar arrangement in the cow by which 
the fetal coverings are in effect buttoned over the 
maternal cotyledons renders the separation of the 
afterbirth difficult and often attended by eversion 
of the uterus. 

It is not the cleansing and replacing of the 
everted uterus, difficult though the operations are, 
that give the veterinarian the most trouble. It is 
keeping the uterus in place during the subsequent 
twelve to seventy-two hours that taxes his pa- 



•Reprinted from the Missouri Valley Veterinary Bulletin, August, 
1909. 



118 SPRINGTIME SURGERY 

tience, ability and ingenuity. Anodynes, sutur- 
ing the vulva, the use of pessaries, surcingles, ele- 
vating the rear of the cow, all have their incon- 
veniences and drawbacks and at times all fail. 

We know in human kind what discomfort and 
pain and even alarming constitutional symptoms 
may result from even a comparatively slight dis- 
placement of the uterus. Having this in mind, it 
occurred to me that possibly the straining and 
consequent eversion of the uterus in the cow may 
be due to the traction upon and resulting dis- 
placement of the uterus by a too closely adherent 
placenta. And that the straining following the 
replacement of the organ was due to a failure on 
the part of the operator to get it into the normal 
position. 

I have recently been trying the long-continued 
effect of gravity on the uterus filled with water 
and in the limited number of cases in which I had 
the opportunity to try it I have been pleased with 
the results. The following case will illustrate : 

A cow that had everted her uterus after giving 
birth to a living calf. I found the animal in an 
old peach orchard that was grown up with under- 



EVERTED UTERUS: REPLACEMENT 119 

brush. She had been walking about considerably 
and the uterus was very much lacerated, swollen 
and bleeding and thoroughly covered with feces 
and other dirt. It was a case where the indica- 
tions were for continued straining. I cleaned up 
this uterus carefully in a warm three percent 
Creolin solution and with considerable difficulty 
replaced it after standing the cow in the stall with 
her hind feet about a foot higher than the front 
ones. She at once began to strain violently. With 
my arm inserted and with the aid of an assistant 
I commenced running in a weak solution of 
potassium permanganate and continued this for 
two hours, when her straining had nearly ceased. 
I instructed the owner to continue the irrigation 
for two hours longer. No other treatment was 
given. The following evening and the next morn- 
ing the owner reported the cow doing fine. She 
did not strain any more and a week later she had 
fully recovered, all discharges having stopped. 



Pervious Urachus* 

By C. L. Wilhite, D. V. S., Manilla, la. 

During the latter part of the period of ges- 
tation the urine passes from the fetus through a 
canal or tube into the allantoic! cavity (a space 
between the outer and inner folds of the placenta, 
the chorion and amnion, and lined with the mid- 
dle fold of the allantois) . This canal is called the 
urachus. When parturition begins this urine con- 
tained in the allantoid cavity is a part of the fluid 
that passes when the placental envelopes break. 

Some authorities claim that pervious urachus 
is caused by a stricture of the urethra, but I have 
found such to be the cause in only a few of many 
cases that I have met. I believe it is caused by 
some freak of nature or a disease which prevents 
closure of the urachus at the bladder at birth or 
soon afterwards. 



♦Reprinted from the American Journal of Veterinary Medicine, 
December, 1911. 



PERVIOUS URACHUS 121 

In cases of pervious or persistent urachus the 
urine passes from the umbilicus in a stream or by 
drops during the act of urination and in occa- 
sional cases drips continuously. The hair around 
the umbilicus is generally wet. As the affliction 
gets older there is a catarrhal discharge and later 
pus. Occasionally, perhaps often, there is an in- 
fection present which if unmolested, works up 
the umbilical vein to the portal vein, then quickly 
to the liver, next the joints swell and the battle 
for life is on. 

In 1907 I treated nine cases of pervious 
urachus which later developed septic arthritis. 
I used ligatures, cautery, injections, and, as the 
disease developed, several pounds of echinacea 
and other drugs too numerous to mention. Eight 
died of the nine and one lived but remained an 
unthrifty dwarf. I had about the same success, 
or rather failure, with my cases in 1908 and 1909. 

In the spring of 1910 a veterinarian recom- 
mended pure oil of turpentine to me as a cure 
for sweeney and gave me a bottle to try. After 
seeing the swelling it caused I decided to try it 
on a case of pervious urachus to close the opening. 



122 SPRINGTIME SURGERY 

I did so, and the leaking stopped in a few hours. 
Since then I have been using it continuously and 
have had only a few fatalities. 

The treatment is as follows: Cast the patient 
without ropes so it may be let up quickly when 
through. Clip the hair around the umbilicus and 
wash with soap and water. Rub dry with a clean 
cloth. Cleanse the urachus with peroxide in a 
syringe with a long, small nozzle clear into the 
bladder. Wash the foam out with pure water. 
Get a few drops of pure oil of turpentine in the 
syringe, insert nozzle into the urachus to within 
an inch and a half of the bladder, as near as can 
be guessed. Inject turpentine slowly drawing the 
syringe out at the same time then let the patient 
up quickly. Inform the owner that the patient will 
do some scratching for a while, and that if the 
navel is leaking in three or four days the treat- 
ment will have to be repeated. Generally one 
treatment will suffice. Occasionally it takes two 
or three. 

Females are more easily cured than males. If 
all the urine passes from the urachus there is a 
stricture of the urethra and it should be cathe- 
terized if possible. 



Care of Navels in Newborn* 

By W. L. Williams, V. S., author of "Veterinary Obstetrics," 
"Surgical and Obstetric Operations," etc., Professor of 
Surgery in the New York State Veterinary College, 
Cornell University, Ithaca, New York 

The care of the navel of the new-born domes- 
tic animal has been the subject of much differ- 
ence of opinion amongst veterinarians and lay- 
men and has been greatly influenced by compari- 
son with the theories and practices of human 
obstetrics. 

In general we accept as a truism in practice 
that a given course of action is alike applicable 
in all mammalia and hence that the correct 
method of dealing with the navel of a child will 
apply to all mammals. There are however some 
very important differences among mammals which 
serve to test the applicability in practice of this 



♦Reprinted from the American Journal of Veterinary Medicine, 
April, 1911. 



124 SPRINGTIME SURGERY 

generally accepted theory. The navel cord of the 
foal and the calf are much more ample compara- 
tively than that of the child or of the young of car- 
nivora. The environment in which young are 
born differs widely, and the care bestowed upon 
the navel cord by the mother also varies greatly. 
The attitude of the young animal further changes 
conditions materially. 

In herbivora the navel cord is normally rup- 
tured by linear tension. It generally parts at a 
particularly frail point near the umbilicus. The 
cord being tensely stretched at the moment of 
parting, the umbilic arteries are much elongated 
and when they finally break, the proximate ends 
recoil, retracting into the abdominal cavity, draw- 
ing with them in an inverted state the surround- 
ing loose perivascular tissue. The ruptured 
arterial stump is thus promptly withdrawn from 
the exterior where it might become infected, and 
the inverted, adherent connective tissue at once 
aids the contracting arterial stump in controlling 
the hemorrhage. The umbilic vein, or veins, col- 
lapse. The stump of the urachus retracts within 
the abdominal cavity between the two arterial 



CARE OF NAVELS IN NEWBORN 125 

stumps. Thus the vessels are promptly out of 
harm's way. The mother next gives the navel im- 
portant attention by licking. This act is gener- 
ally supposed to be purely cleansing but it is very 
much more. When intact, the naval cord is 
largely made up of the gelatinous, semi-fluid 
Whartonian gelatin which if left in the cord 
affords an excellent breeding ground for patho- 
genic microorganisms. This fluid, under normal 
conditions, slowly oozes from the stump of the 
cord and the latter finally desiccates, but the 
mother greatly hastens this process by a kind of 
tongue-massage. The fluid is forcibly pressed out 
during the licking process. This is especially em- 
phasized in the cow with her rough, prehensile 
tongue, with which she exerts much force. In 
harmony with this, calves suffer far less from 
navel infection than do foals, whose navels get 
less tongue massage from the mother. In fact 
naval infection in calves is seen mostly in those 
early removed from their dams and this natural 
care of the navel by the mother prevented. 

Ligation Harmful. — Many veterinarians and 
most veterinary obstetricians advise or practise 



126 SPRINGTIME SURGERY 

the ligation of the navel cord of the new-born. 
They do not generally state their reasons there- 
for. It was advised by Nocard for the preven- 
tion of "white scours" in calves, though just why 
it should prevent this dreaded disease is not clear. 
It certainly can not prevent the entrance of in- 
fection through the navel. We may limit infec- 
tion to some extent by a ligature around a living 
tissue, as when we ligate a hernial sac, but even 
there our power is vague. In that case however 
we apply the ligature to living, active tissues, 
cutting off nutrition on one side of the ligature 
and leaving it comparatively undisturbed on the 
other side, where a protective wall against any 
threatening infection is quickly established. In 
the navel cord it is quite otherwise. The interrup- 
tion of the placental circulation and establish- 
ment of the pulmonary functions renders the um- 
bilic stump a dead mass of tissue. The arterial 
stumps and the urachus have retracted and are 
no longer in the cord, while the vein or veins have 
wholly ceased to function and are dead. The re- 
maining umbilic tissues, the amniotic sheath of 
the cord, the areolar tissue and Wharton's jelly 






CARE OF NAVELS IN NEWBORN 127 

included within it are dead and all that now re- 
mains of the navel stump must ooze away, desic- 
cate or decay. It must be clear to anyone that a 
ligature applied around a columnar mass of dead 
tissues can not prevent the invasion of bacteria 
on either side of the ligature; it can not hold 
either the distal or proximal tissue against bac- 
terial invasion. 

Fortunately for the calf the navel cord usually 
ruptures before the birth act has been completed 
and the arterial and urachal stumps have re- 
tracted within the abdomen out of reach of the 
meddler. In the foal the navel cord is longer and 
a ligature may be applied before it is ruptured 
and the arteries and urachus become incarcerated 
and their infection rendered probable. 

The most serious objection to ligation lies in 
the fact that the ligature imprisons within the 
amniotic sheath all of Wharton's jelly and all blood 
which may ooze from the withdrawn arterial 
stumps if they have retracted. If the arteries 
have not retracted and are caught in the ligature 
a large blood clot is imprisoned just above the 
ligature; any urine oozing from the retracted 



128 SPRINGTIME SURGERY 

urachus is also imprisoned, and any blood re- 
maining in the umbilic vein or veins is likewise 
retained. This retention of liquids within the 
dead tissues serves to invite infection and is in 
direct conflict with surgical principles, one of the 
most fundamental rules of which is the ample pro- 
vision of free drainage for all inactive useless fluids. 
Sources of Infection. — The ligation of the 
navels of new born domestic animals is rarely 
carried out under aseptic or antiseptic precau- 
tions of even a crude character; usually the 
hands of the ligator, and the ligature are bear- 
ers of infection. After meeting this danger the 
foal or calf spends much of its time with the navel 
stump in contact with dung or other filth. When 
standing the moist navel stump is a favorite feed- 
ing place for flies, bearing various infections. 

But it is held, the human obstetrician ligates 
the navel stump and why should not we also? 
The cases are not parallel. The human obstetri- 
cian ligates the cord under careful antisepsis, 
after expressing the jelly of Wharton and other 
fluids, then applies antiseptic or aseptic dress- 
ings to the wound which is retained in place by a 



CARE OF NAVELS IN NEWBORN 129 

clean bandage and the infant is kept ir a dorsal 
recumbency with no opportunity for fecal, urinal 
or other soiling of the dead stump. 

Navel Hemorrhage Not Serious. — If the liga- 
tion of the navel cannot prevent infection there 
would seem to be but two other reasons for the 
procedure, hemostasis and fashion. In an exten- 
sive obstetric practice extending over thirty-two 
years the writer has not observed fatal or impor- 
tant naval hemorrhage and has learned of but 
one case from his fellow veterinarians. That one 
case was in a foal, belonging to a veterinarian 
who ligated the cord. Apparently he had excised 
the cord too long, the excised arterial stumps re- 
tracted up through the ligature and failed to 
close as the ruptured end would have done, the 
escaping blood accumulated above the ligature, 
distending the amniotic sheath of the cord, pushed 
it off and permitted the fatal hemorrhage. 

Fatal umbilic hemorrhage rarely, if ever, fol- 
lows the normal division of the umbilic cord by 
linear tension (herbivora) or by gnawing (carniv- 
ora). Ligation is wholly superfluous from a 
hemostatic standpoint and if accompanied by ex- 



130 SPRINGTIME SURGERY 

cision of the cord adds greatly to the danger from 
hemorrhage because an excised artery bleeds 
more freely than an artery severed by any other 
method. Clinically an artery is generally not 
held by a ligature about the cord, especially if the 
cord is divided reasonably short. As that is the 
case in most navel ligations the control of the 
hemorrhage is due, not to the ligation but to auto- 
hemostasis, in the ordinary course of the normal 
physiologic powers of the umbilic arteries. 

If we examine the question clinically we find 
that the above conclusions are borne out by every- 
day experience. 

Prevention of Infection.— Foal after foal 
perishes from navel infection and a far larger 
percentage of foals succumb with, than without, 
ligation. On the other hand, navel infection is 
uniformly prevented by open antiseptic, desiccant 
handling of the navel. If the normally ruptured 
navel, or the navel artificially divided in a man- 
ner simulating the natural method (linear ten- 
sion, scraping, ecrasement) under antiseptic pre- 
cautions — the jelly of Wharton pressed out and 
a desiccant antiseptic applied navel infection is 



CARE OF NAVELS IN NEWBORN 131 

promptly and effectively barred. If the freshly 
ruptured navel, from which the Wharton's jelly 
and other fluids have been expressed, is immersed 
in a 1-1000 corrosive sublimate solution for fifteen 
to twenty minutes it will have become well dis- 
infected. This may be conveniently accomplished 
by filling a cup with a solution and pressing it 
against the abdominal floor around the navel, 
thus immersing the navel stump within the solu- 
tion. After this thorough disinfection, desicca- 
tion of the stump may be hastened and the sealing 
of the wound against infection insured by dust- 
ing the stump over with a powder consisting of 
equal parts of gum camphor, alum and starch, 
finely powdered. This may be repeated every 
thirty minutes until the desiccation is complete 
and a hard, dry antiseptic scab is the sole rem- 
nant of the umbilic stump; the wound is sealed 
and infection is excluded. 

If sure that the navel is reasonably clean, the im- 
mersion of the stump in the corrosive sublimate 
solution may be safely omitted and the desiccating 
antiseptic powder at once applied. Or after the 
cord has been ruptured and the fluids expressed 



132 SPRINGTIME SURGERY 

from the stump it may be efficiently disinfected 
and desiccated by the application of tincture of 
iodine, but this needs be done with great care, 
lest the skin about the navel be blistered. Iodine 
is not wholly safe in the hands of the layman, and 
it is the layman who must usually care for the 
navel of the new-born under directions from the 
veterinarian. 

While we frequently see glowing accounts of 
how navel infection in new-born animals has been 
cured by this or that veterinarian by bacterins or 
other very remarkable remedies, the conservative 
veterinarian would as yet prefer secure prophy- 
laxis to glorious, sensational cures. He may not 
get as much money out of it, but he will gain 
much in satisfaction and in professional standing. 



Superfetation With Report 
of a Case* 

By R. F. Bourne, B. Sc, D. V. S., Professor of Physiology, 
Kansas City Veterinary College 

By the term superfetation is meant conception 
in an animal already pregnant before the termi- 
nation of the primary period of gestation. This 
term should not be confused with superfecunda- 
tion — the fertilization of two or more ova of the 
same ovulation by separate copulative acts. 

Opportunity for erroneous conclusions in cases 
of this character is so great that some authori- 
ties have doubted the possibility of its occur- 
rence; but there are recorded, several indisputa- 
ble cases of superfetation and doubtless some who 
read this may recall occurrences in their own ex- 
perience. However, these instances seem to be 



♦Reprinted from the Missouri Valley Veterinary Bulletin, July, 1909. 



134 SPRINGTIME SURGERY 

exceedingly rare; far rarer than cases where 
double conception has resulted from connection 
with two different males at intervals separated 
only by a few hours. Fleming records cases 
where women have borne twins, one white and 
one mulatto, from copulation with a white man 
following that with a negro or vice versa, and 
similar cases where a horse and a mule colt were 
delivered at one birth when service with a horse 
and a jack was had on the same day. These are 
cases of superfecundation. 

The more remarkable instances are those in 
which conception has occurred from two copula- 
tive acts, weeks or months apart (superfetation), 
and where each fetus is carried for the full period 
of gestation. One of these cases occurred in New 
York in 1876. A five-year-old mare bore a fully- 
developed, well-formed dead colt on February 
twenty and on the second of April another sound, 
healthy fully-developed live colt. Other cases in 
which two fetuses in different stages of develop- 
ment have been delivered at one birth are more 
frequent. The following case of this kind re- 
cently came under my observation. 






SUPERFETATION 135 

I was called by a farmer who reported that 
he had a mare which had foaled and which was 
not behaving properly. Upon my arrival about 
nine p. m., I found a black, twelve-year-old mare 
exhibiting symptoms of mild colic and treated 
her accordingly. Vaginal exploration revealed 
conditions normally present after parturition. 
The owner then related the following history: 
The mare had been purchased by him five months 
before, and was said to be in foal from a horse 
or jack, she having been bred to both. She had 
been served first by the jack, and in order to in- 
sure conception was returned, some three weeks 
later, to the town where the jack was kept. In 
the meantime, however, the jack had been re- 
moved and the owner allowed the mare to be 
served by a percheron stallion. So far as the 
present owner knows no subsequent service was 
had and the opportunities for it seem very re- 
mote, judging from the conditions under which 
most farm mares are kept. 

A few hours prior to my call the mare gave 
uneventful birth to two colts, one an immature 
mule and shortly after a well-formed full-term 



136 SPRINGTIME SURGERY 

horse colt. Both were dead. The mule's body- 
was not yet completely covered with hair and its 
size was not more than one-third that of the 
full-term foal. 

The only explanation I can offer as to the im- 
mature state of this foal was that it had been 
carried dead for some months and had resisted 
decomposition and mummification until normal 
conditions had delivered it along with the horse 
colt. The carrying of a dead fetus for this 
length of time is not rare and unless service was 
had with a jack at a later period than that with 
the stallion, we must accept some such explana- 
tion. Parturition occurred about two weeks be- 
fore the normal period of gestation, for the 
horse colt, had expired. 



Atresia Ani 



By A. T. Kinsley, M. Sc, D. V. S., Pathologist, Kansas City 
Veterinary College, Author of "Veterinary Pathology" etc. 

During the embryonic stage of intrauterine 
life the specialized tissues and organs are formed. 
The fetal period is the time during which the 
structures formed in the embryonic stage grow 
and develop. At birth the young of a given 
species are of a definite shape, contour and type; 
the form or type which is most common is ac- 
cepted as normal; and deviations from the nor- 
mal are designated malformations, anomalies or 
developmental errors. Many new strains and 
breeds of live stock have been the result of de- 
velopmental errors becoming a fixed peculiarity. 
Thus the polled cattle, the Boston bull-dog, the 
Mexican (hairless) dog, and the five-toed chicken 
had their origin. 

A variety of malformations are of course 
seen at the season when veterinarians are called 



♦Reprinted from the Missouri Valley Veterinary Bulletin, June, 1908. 



138 SPRINGTIME SURGERY 

to attend cases of parturition. Obstetrical cases 
in addition to the general practice entails the ex- 
penditure of considerable energy and the prac- 
titioner may not be as careful and observing in 
some cases as he should be. 

Atresia ani is a malformation that is not rare 
and is frequently not observed by the attending 
obstetrician. This malformation is the result of 
imperfect union of tissues. During the earlier 
stages of development, i. e., the embryonic period, 
the digestive tract from the pharynx to the rec- 
tum inclusive is formed from the entodermal 
tube. The anus is formed in the fetal stage by 
invagination of the skin surface, the anus and 
rectum are at this stage separated by a thin 
membrane. Normally the rectal and anal walls 
fuse, the separating membrane is absorbed and 
thus there is produced a continuous canal. 

Failure of the anal invagination, failure of 
fusion of the anal and rectal walls, or failure of 
solution of the separating membrane would re- 
sult in an imperforation and there would be no 
outlet for the escape of the contents of the diges- 
tive tube. 



ATRESIA ANI 139 

The communication between the bladder and 
intestine may persist thus allowing the fecal mat- 
ter to discharge into the bladder. A communica- 
tion may also occur between the intestine and 
urethra or the intestine and vagina. 

The young of any domestic animal could not 
survive long without evacuation of the contents 
of the digestive tube. Atresia ani occurs most 
frequently in pigs and calves, though colts and 
other animals are not exempt. This, malforma- 
tion is usually easily relieved by an operation the 
nature of which depends upon the specific con- 
dition existing. If there has been failure of ab- 
sorption of the separating membrane it may be 
ruptured by the use of a blunt instrument no 
further treatment being necessary. In those 
cases resulting from the failure of fusion of the 
rectal and anal walls, the intervening tissue 
should be very carefully dissected and the walls 
of the rectum and anus approximated and 
sutured. When there has been a failure of cuta- 
neous invagination a crucial incision should be 
made through the skin and the intervening tissues 
bluntly dissected to the lumen of the rectum, then 



140 



SPRINGTIME SURGERY 



the mucous membrane of the rectum should be 
pulled outward, sutured to the skin or margins of 
the opening made by the dissection so that the 
mucous membrane and skin are continuous and 
form a lining for the artificial opening. 

If there is a communication between the intes- 
tine and the bladder urethra, or vagina it should 
be closed by a plastic operation and the external 
opening made as indicated above. 



Treatment of Contracted 
Tendons in Foals* 

By James Smellie, M. D. C, Eureka, Illinois 

The title of this paper should really be "Treat- 
ment of Contracted Tendons and Ligaments in 
Young Colts/' because in the majority of cases 
the ligaments are just as much at fault as are the 
tendons. The contraction of one or both of these 
structures is a condition that the country prac- 
titioner meets very often, and in most cases, it is 
quite serious. 

Every year we see a number of colts born with 
such marked contraction of the flexor tendons and 
posterior ligaments of the forelegs that the ani- 
mal knuckles over on the fetlock joint, and is un- 
able to extend the phalanges. The condition, if 
allowed to continue very long, causes an undue 



♦Reprinted from the Missouri Valley Veterinary Bulletin, Feb., 1910. 



142 SPRING-TIME SURGERY 

extension of the extensor pedis tendon, and also 
of the anterior part of the capsular ligament. 
This, combined with the bruising of the skin, from 
contact with the ground sets up a thickening over 
the joint that is apt to remain. 

In some colts the flexure is at the carpus. In 
such cases the metacarpal muscles and check liga- 
ments are most affected; in some cases delivery- 
is effected with the front legs flexed. I have seen 
a few cases of this condition in the hind legs, with 
the contractions at the fetlock and the flexor ten- 
dons most affected. 

Etiology. — This malformation is caused, I be- 
lieve, by the limbs becoming flexed in utero and 
for some inexplicable reason, remaining that way 
too long. It may possibly be hereditary in some 
cases, when one or both parents have upright 
shoulders and short straight pasterns. I know 
of a mare of such conformation that has had two 
colts in succession, sired by the same horse, that 
knuckled completely over on one front fetlock, 
and could touch the ground with only the toe of 
the other leg. Her colts were sound when sired 
by another horse. 



CONTRACTED TENDONS IN FOALS 143 

Treatment.— Only in those cases where the 
colt was lively and energetic have I ever been 
successful in my treatment of them. When the 
animal is young the ligaments and tendons will 
stretch a long way if the limbs can be brought 
into position so the animal can use them. 

In the hind leg, it is comparatively easy, pro- 
vided the flexors are not too short. I make a bar 
shoe exactly the size of the foot with a projection 
coming straight forward about three inches, then 
turning it up to form a brace to which the limb is 
strapped. The fetlock joint forms an admirable 
fulcrum for the brace, and every time the ani- 
mal stands up it stretches the tendon, which soon 
allows the foot to assume its natural position. If 
there is too much contraction section of the per- 
forans has to be performed. 

In the front leg, treatment is more difficult, be- 
cause all joints flex in one direction. I make a 
bar shoe exactly the size of the foot with a forked 
projection in front extending from two to four 
inches. If the joint is weak and inclined to break 
over outward, it may be necessary to weld on a 
spur on the outside of the shoe. It is necessary 



144 SPRINGTIME SURGERY 

to raise the points of those projections and give 
the foot a rolling motion backwards. The feet 
are very soft for a few days, but generally about 
the third or fourth day, the hoof is hard enough 
to hold the nails. 

In a few cases where the joints were weak, I 
have had to put on a plaster cast for a few days 
to stiffen the joints enough so the animal could 
get in the habit of using its feet. 

When the carpus is affected, tenotomy of the 
metacarpi medius and the perforans tendons has 
to be performed. 



Minor Means of Restraint 

By D. M. Campbell, D. V. S., Chicago 

The veterinarian and particularly the young 
veterinarian who can control his patient with the 
least expenditure of time and energy on his own 
part as well as with the greatest measure of 
safety to himself and to the animal is in a fair 
way not only to do better surgery because of 
this perfect control but to win favor with his 
clients and a reputation for "horse sense" which 
is so necessary to one who would be considered 
by stockmen a master in his profession. 

On the other hand the inability to cast, throw 
or tie an animal as well as the owner himself can, 
is one of the greatest handicaps a veterinarian 
can have, not only because of the actual incon- 
venience to which he is subjected but also be- 
cause of the lessened respect — the almost con- 
tempt the owner will have for a veterinarian on 
this account alone. A veterinarian's clients ex- 



146 SPRINGTIME SURGERY 

pect him to know more about their animals than 
they themselves do and regard with suspicion the 
knowledge of a veterinarian who knows less 
than they about controlling animals. 

An ever-present example of the above may be 
seen in the regard most horsemen have for the 
incompetent veterinary dentist who, though he 
knows very little about a horse's teeth and their 
abnormalities, from long practice is able to handle 
the horse while dressing the teeth in a very skill- 
ful manner, and to float the teeth quickly, without 
the use of a speculum and with almost no resist- 
ance from the patient. Contrast the effect of 
such "smooth work" with the bunglesome method 
of some competent though unpracticed veter- 
inarian who has done little of this work and 
whose final results when the work is completed 
are infinitely better than the other, and one may 
see at once how much horsemen appreciate 
"horse sense" — "handiness." 

Nothing else is quite equal to ingenuity and 
of course common sense in handling animals. 
To some extent every case presents its own prob- 
lem; but a few suggestions that are capable of 



MINOR MEANS OF RESTRAINT 147 

modification to apply to a large variety of cir- 
cumstances may be useful, particularly to the 
recent graduate in veterinary medicine whose 
boyhood and early manhood was not spent on a 
farm or among animals. 

To Handle the Hind Feet of an Unbroken 
Horse*. — Take a piece of five-eighths inch rope 
with a noose at one end that will not slip and 
large enough to go around the neck near the 
shoulder, then put a half -hitch around the body, 
just back of where the backhand of a harness 
comes, then take on back through a strap buckled 
firmly around the root of the tail. To this fix a 
ring or a knot and connect a small block-and- 
tackle with it and to a hobble on the foot to be 
raised. A ten-year-old boy can do the rest. 

To Pass the Knisely Stomach Tube* — Draw 
very tightly around the nose a common haine 
strap, this is placed just high enough so as not 
to interfere with the animal's breathing. Then 
lubricate the tube and pass it in through the in- 
terdental space and down the esophagus as usual. 



*By H. B. Treman, D. V. M., Rockwell City, Iowa ; reprinted from 
the Missouri Valley Veterinary Bulletin, July, 1909. 



148 SPRINGTIME SURGERY 

The animal breathes much easier than it does 
when a mouth speculum is used and consequently 
does not resist the operation so strenuously. Be- 
sides, the little strap is far more convenient to 
carry than a heavy speculum. I also think that 
the tube is less liable to enter the trachea when 
so used than it is with the mouth held open. 

Restraint for Cattle. — I have been surprised 
to find some veterinarians unfamiliar with the al- 
most universal means or method for throwing a 
cow, and many others that though familar with 
this means of throwing the animal have thought 
that after the animal is thrown it needs further 
tying to hold it down for various operations. 
This is not the case. Two ropes, one with which 
to tie the animal by the head and another single 
rope twenty-five feet long are sufficient for one 
man to throw and hold the largest bull for an 
operation for actinomycosis or for putting a ring 
in his nose or for almost any other operation 
except upon the feet and legs. 

To cast and control cattle where one has not 
the assistance of trained cow men and cow horses 
or ponies, select a piece of sloping ground, the 



MINOR MEANS OF RESTRAINT 149 

steeper the slope the better within reasonable 
limits. Tie the animal by the horns or with a 
halter at the ground to a strong stake or post, 
then loop one end of a strong rope around the ani- 
mal's neck near the shoulder. Tie the loop so 
that it will not slip. Take a "half hitch" or loop 
behind the shoulder and another just in front of 
the anterior angle of the ilium and the udder or 
scrotum. The first of these "half hitches" is not 
essential but the second is very necessary. Then 
get the animal to stand back from the post to 
which it is tied as far as possible and pull steadily 
and strongly upon the rope, determining the side 
upon which you want the animal to lie by pulling 
at a slight angle. 

If in falling the animal should slacken the rope 
by which it is tied at the head it must be allowed 
to rise and the throwing repeated and kept up 
until the animal falls with the head rope taut. 
With a very little experience the operator will be 
able to accomplish this quickly, usually at the first 
throw, and in no case requiring more than two 
attempts. 



150 SPRINGTIME SURGERY 

After the animal falls keep the rope tight and 
it will very soon cease to attempt to rise. Then 
have an assistant take the rope and pull strongly 
upon it almost at a right-angle to the long axis of 
the animal's body, standing just a little bit back 
of where a right angle line would run. Allow 
the legs to remain free and the animal to use 
them as much as it likes. In this way the strug- 
gling will do no harm and even cows heavy with 
calf may be operated upon for lump jaw or other 
ailments without the slightest danger of produc- 
ing an abortion or otherwise injuring them. 

With the animal in this condition an operation 
upon the fore feet or fore legs offers little diffi- 
culty. Simply flex the legs strongly and tie them 
there. The hind feet offer a little more difficulty, 
particularly if it is desirable to keep an animal 
in an advanced stage of pregnancy from injur- 
ing itself through struggling, but the ingenious 
veterinarian will have little difficulty. 

To Control Cattle in a Standing Position.* 
— For castrating old bulls, or for giving them 



♦Reprinted from the American Journal of Veterinary Medicine, July, 
1911. 



MINOR MEANS OF RESTRAINT 151 

tuberculin injections, when they evince a desire 
to kick and for many other operations not upon 
the head, cattle may be restrained without going 
to the trouble to cast them, by the following very 
simple expedient: 

Have the animal securely tied by the head and 
take two strong poles — fence rails serve admira- 
bly, and cross them beneath the animal. Two 
assistants should then lift upon the rails, so that 
the animal rests, just in front of the udder or 
scrotum, a part of the weight upon the rails 
crossed saw-buck fashion with the long ends up. 

To Break a Horse From Pulling Back. — 
One may often curry much favor with his clients 
by showing them how to break a horse from pull- 
ing back upon the halter. This is a very simple 
matter and one with which every veterinarian 
should be familiar. 

Take any strong rope but preferably a new 
three-eighth-inch hard twisted one such as is used 
for lariats and make a small, non-slipping loop 
in one end. Place the rope about the horse's body 
just posterior to the fore legs, run the free end 
of the rope through this loop, take it between the 



152 SPRINGTIME SURGERY 

forelegs and forward through the ring in the 
head stall of the halter. Tie to the manger or a 
post or anything solid, just short enough so that 
when the animal backs as far as this rope will 
let him he will still lack about a foot of taking 
up the slack in the halter rope and then leave 
him to his own salvation, or if he should refuse 
to pull, after a reasonable time, induce him to do 
so by "shooing" him or slapping him over the 
head with a sack or something of that kind. It 
is best, however, to let him get caught at his old 
trick of his own initiation. The tightening of the 
rope about the chest will frighten the animal very 
much and he will at once spring forward and will 
not repeat the process until he forgets about it. 
Three or four experiences of this kind are usually 
sufficient to break the habit in the worst puller. 






The Treatment of the 
Injured Hand ' 

How to Cleanse it and How to Examine it 

By Ralph St. J. Perry, M. D., Santa Fe, Isle of Pines, Cuba 

[Editor's Note. — Minor injuries to the hands that are infected dur- 
ing their work and become serious are of such common occurrence 
among veterinarians that no apology is required for presenting this 
excellent article, a chapter from Dr. Perry's book on "The Injured 
Hand," here even though it deals with no phase of veterinary surgery. 
The principles here given apply alike to minor surgery of both man and 
animals. Dr. L. A. Merillat, the most widely read surgeon among 
veterinarians has pronounced this article the best "surgery" that has 
ever appeared in a veterinary publication.^ 

Probably every accidental wound is an infected 
wound. Out of several hundred of such injuries 
only two were found to be noninf ected when sub- 
jected to bacteriologic tests. The infection usually 
is coincident with the injury, and it is doubtful 
whether any method of wound cleansing has yet 
been devised which will surely and immediately 
eliminate this primary infection. 



♦Reprinted from the American Journal of Veterinary Medicine, No- 
vember, 1910. 



154 SPRINGTIME SURGERY 

The rapidity with which infection can spread 
from one portion of a wound to another, or from 
an infected wound to adjacent healthy tissues, is 
startling. Schimmelbusch inoculated the tip of a 
mouse's tail with anthrax germs and ten minutes 
later cut off the tail at its root ; the mouse died of 
anthrax. Reichel maintains that one minute after 
inoculation the most thorough antiseptic treat- 
ment is powerless to prevent infection. What, 
then, can be expected where an injury is rarely 
seen by the surgeon until fifteen minutes after its 
infliction, while oftener it is thirty minutes or an 
hour? 

Observation and experiment have proved that 
powerful antiseptics devitalize the tissues and do 
more harm than good. This is particularly true 
of carbolic acid, cresylic acid and corrosive sub- 
limate. These are cited because they are the ones 
most commonly used by the profession and laity, 
and the most dangerous. If it be true that these 
antiseptics cannot prevent or counteract infec- 
tion and that they by their destructive action upon 
the tissues really tend to create a field for the de- 
velopment of germs, why use them at all? The 



TREATMENT OF INJURED HAND 155 

question is a proper one, and my answer is, Don't! 

Don't use carbolic acid. 

Don't use cresylic acid ! 

Don't use corrosive sublimate! 

But if not these, what would you use? It is 
desirable to use an antiseptic which will prevent 
further infection and the further development of 
infecting germs already in the wound. We want 
a protective and preventive which is not caustic 
or irritating, something that will cleanse without 
doing injury and which will guard against the 
assaults of extraneous germs. 

Surgical Cleansing of the Injured Hand. — 
The vast majority of injured hands are those of 
mechanics and laboring men and come to the sur- 
geon smeared with machine grease, paint, varnish, 
mud, mortar, sawdust, flour, tobacco quids, cob- 
webs, and many other substances which are a part 
of honest labor or which have been applied to the 
wound in well-meant but misguided efforts to stop 
bleeding or ease pain. To remove these substances 
I use three applications : 

Warm saline solution, 

Gasolin, plain and iodized, 

Warm solution of mercuric cyanide. 



156 SPRINGTIME SURGERY 

The saline solution (a teaspoonful of clean table 
salt to each pint of boiled water) is familiar to all 
and needs no special mention. It is used to re- 
move the grosser portions of the dirt — the term 
"dirt" being here employed as applying to all mat- 
ter out of place. 

Use Gasolin to Remove Oil and Grease.— 
In cases where the injured parts are soiled with 
machine grease, paint, oil, varnish and similar 
substances not removable by water, resort is had 
to ordinary commercial gasolin. The use of gaso- 
lin for this purpose, while not general, is not a 
novelty. I have so utilized it for more than 
twenty-five years; others have used it, and it is 
now quite generally used by surgeons who have 
much factory, machine-shop or railroad surgery. 
While acting as a solvent for fats, oils, gums, wax 
and resins, it is, to a certain extent, antiseptic, be- 
sides causing no pain; hence it makes an excel- 
lent detergent when the parts are besmeared with 
such substances. 

The addition of resublimed iodine to the gasolin 
(one dram to the pint) increases its antiseptic 
powers without affecting its detergency. Iodized 



TREATMENT OF INJURED HAND 157 

gasolin should be freshly prepared, in small 
quantities, at the time of use. 

To use the gasolin, pour it directly upon the 
wound from a small-mouth bottle, letting it 
wash all over portions of the injury; also make 
a mop of absorbent cotton or gauze, saturate with 
the gasolin and gently rub over the parts until 
cleansed. If the dirt be unusually tenacious, a 
soft tooth-brush may be used. The body-heat 
causes the gasolin to evaporate from the surface, 
leaving the parts clean and dry. 

Gasolin is almost as efficient as hydrogen per- 
oxide in breaking up adherent clots, and is not 
painful. 

By way of caution : The surgeon must remem- 
ber that gasolin vapor is highly inflammable, even 
explosive ; also, that if it gets into the eye, ear or 
closed cavities it may cause pain, just as do ether, 
chloroform and other quickly volatilizing liquids. 
Benzin may be substituted in an emergency. 

Mercuric Cyanide Solution. — The mercuric- 
cyanide solution has been a favorite cleansing so- 
lution with me for many years. Since I first called 
attention to its use in antiseptic surgery (in 1898) 



158 SPRINGTIME SURGERY 

its use has become quite general because of the 
following advantages: 

Mercuric cyanide is freely soluble in hot or cold 
water, and in alcohol ; it does not stain the finger- 
nails or give rise to eczema or other inflamma- 
tions of the skin; it does not coagulate albumen 
in blood, mucus, purulent or other discharges or 
excretions; it is not precipitated or decomposed 
by soap ; it does not corrode steel, nickel or silver ; 
it can be used in any kind of a vessel — enameled, 
porcelain, tin, papier-mache or wooden; it is in- 
expensive. 

Some of my critics, especially the laboratory 
bacteriologists, have maintained that mercuric 
cyanide is not an antiseptic, that it will not in- 
hibit germ growth ; but to these I say that I have 
used it for now more than ten years, and the re- 
sults have been more satisfactory than I obtained 
from other antiseptics. The practical experience 
of many other surgeons corroborates my own. 

Other critics say it is too dangerous an anti- 
septic for general use, that its lethal effects are 
too sudden should one of the laity accidentally 
swallow some of it. But these should remember 



TREATMENT OF INJURED HAND 159 

that this agent is for the use of surgeons and not 
of the laity, that the latter have no business with 
it, and that in the hands of a competent surgeon 
it is as safe as an amputating knife or other in- 
strument. 

In cleansing the parts around a wound it is 
sometimes desirable to use soap, and I have 
found "mechanics' soap," a coconut-oil soap plus 
fine sand, or rather stone, as good as any of the 
higher-priced antiseptic soaps. If desirable, an 
antiseptic solution may be used as a rinsing appli- 
cation after the soap. 

Hydrogen peroxide I do not often use in pri- 
mary cleansings, since little difficulty has ever 
been experienced by using the methods just de- 
scribed. Before attempting to cleanse a wound 
always apply a tourniquet to prevent further 
bleeding. 

Examination of Injuries. — Having cleansed 
the wound of all extraneous matters, the surgeon 
should see to it that his own hands are again ren- 
dered surgically clean, after which he may pro- 
ceed to examine into the nature and extent of the 
injuries. 



160 SPRINGTIME SURGERY 

In making such examination, use the fingers 
rather than instruments, as much as possible, but 
gently, very gently, depending upon the tactile 
sense to determine what conditions exist, using 
the eyes, ears and nose as aids to the sense of 
touch. 

The tactus eruditus, the educated sense of touch, 
is nowhere of greater importance than in surgi- 
cal practice. While manual dexterity is advan- 
tageous in the technic and mechanical work of the 
profession, the great importance of a correct 
diagnosis speaks for the value of the educated 
touch. This tactus eruditus can be rapidly and 
readily acquired in the everyday experiences if the 
student or practitioner will only make the effort 
to determine size, shape, surface qualities and 
other physical attributes by the touch, thus learn- 
ing to identify objects by their "feel." 

Care in Handling. — Simple superficial wounds 
will require very little handling; incisions, punc- 
tures and lacerations due to known causes call 
for nothing more than a careful inspection. Where 
the presence of a splinter of wood, metal or glass 
is suspected, a very gentle digital examination 



TREATMENT OF INJURED HAND 161 

will discover the foreign body more readily than 
a rough examination or probing with a metallic 
probe. 

In searching for deeply imbedded foreign 
bodies, use the probe as little as possible. If the 
body be a bullet, needle or other metallic substance, 
use the x-ray. The indiscriminate use of the 
probe in bullet wounds, fractures, necroses, sin- 
uses, etc., cannot be too strongly condemned. 
Modern methods are so much more superior, defi- 
nite and less dangerous that the probe has been 
to a large extent rendered obsolete and should 
only be resorted to when other methods are not 
at command. 

The tactile sense should easily detect fractures 
and dislocations if the parts be not swollen too 
much, and in open wounds of joints should be able 
to determine the condition of the cartilage sur- 
faces. Should it be necessary to use instruments 
in examining a wound, they should be sterilized. 

The Sense of Smell. — The sense of smell k 
of much assistance in determining the condition 
of wounds, as all emit characteristic odors of 
fresh blood, "healthy" pus, tissue necrosis, etc., 



162 SPRINGTIME SURGERY 

according to their age, stage of healing, infections 
and dressings.- 

The odors given forth by wounds may be more 
or less modified by those natural to the body, due 
to the perspiration and other cutaneous secre- 
tions. In ordinary persons this odor is sulphur- 
ous, especially so in red-haired and freckled indi- 
viduals; brunettes possess a prussic-acid and 
blondes a feeble musk odor; fat persons have a 
more pronounced odor than lean ones, the former 
frequently having an oily odor due to excessive 
fatty acids in the sebaceous secretions. Race, sex, 
age, personal cleanliness and complicating skin 
diseases also influence the odors of wounds. 

Various foods and some medicines taken inter- 
nally impart odors to the skin secretions which 
may modify the normal wound odors, and local 
applications to the seat of injury may be expected 
to do so. 

A recent undressed wound presents the odor of 
fresh blood, which, if there be union by first in- 
tention, gives way to that of the dressings ap- 
plied. A wound bathed in pus from healthy gran- 
ulations gives a characteristic odor which is not 



TREATMENT OF INJURED HAND 163 

offensive; if, however, there be necrosis, decom- 
position of the discharges or maceration of callo- 
sities or scabs, there is a very pronounced and dis- 
agreeable odor of putrefaction. I have noticed in 
wounds in syphilitics a characteristic odor, also in 
those made by ice-cutting tools, and in human 
bites. Wounds infected with glanders or diph- 
theria present the peculiar odors of those diseases. 
All these things the experienced surgeon bears in 
mind. 

Macroscopic inspection of wounds will reveal 
much concerning their extent and condition, but 
the eye must be supported by the touch, as there 
are many things in an injury which the eye cannot 
detect and many appearances which are highly de- 
ceptive. In cases where there is doubt as to the 
nature of infection resort is had to bacteriologic 
culture and miscroseopic examinations. 

A most important adjunct to the ocular exami- 
nation of injuries is the x-ray apparatus whereby 
fractures, dislocations, bone inflammations and 
necrosis can be definitely determined and metallic 
bodies located. 



A?a 7 1913' 






